Inciarte-Mundo José, Victoria Hernández Maria, Ruiz-Esquide Virginia, Raquel Cabrera-Villalba Sonia, Ramirez Julio, Cuervo Andrea, Pascal Mariona, Yagüe Jordi, Cañete Juan D, Sanmarti Raimon
Hospital Clinic, University of Barcelona, Barcelona, Spain.
Arthritis Care Res (Hoboken). 2016 Jul;68(7):899-906. doi: 10.1002/acr.22795.
To compare the accuracy of serum calprotectin and acute-phase reactants (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) in stratifying disease activity in rheumatoid arthritis (RA) patients receiving tumor necrosis factor inhibitors (TNFi), and to correlate calprotectin levels with TNFi trough serum levels.
We conducted a cross-sectional study of 87 RA patients receiving adalimumab, etanercept (ETN), or infliximab (IFX); 56 psoriatic arthritis (PsA) patients and 40 healthy blood donors were included as controls. Associations between calprotectin, CRP, and ESR and composite articular indices (Disease Activity Score in 28 joints [DAS28], Simplified Disease Activity Index [SDAI], and Clinical Disease Activity Index) were analyzed by correlation and linear regression and the accuracy and discriminatory capacity of calprotectin by receiver operator characteristic curves (area under the curve [AUC]).
Calprotectin levels correlated better with all composite activity indices than CRP and ESR (all r coefficients >0.70). Calprotectin levels were significantly lower in RA and PsA patients in clinical remission compared with those with low disease activity for all articular indices. In RA, ESR discriminated between remission and low disease activity only when using DAS28, and CRP only with SDAI. In RA patients in remission/low disease activity, calprotectin but not CRP or ESR distinguished between patients with no swollen joints and those with ≥1 swollen joint (1.74 μg/ml versus 3.04 μg/ml; P = 0.010). Using DAS28 ≥2.6 as the reference variable, calprotectin showed an AUC of 0.92; the best cutoff was ≥2.47 μg/ml with a likelihood ratio of 6.3 (95% confidence interval 2.5-15.8). Calprotectin serum levels inversely correlated with trough serum drug levels of ETN (ρ = -0.671, P < 0.001) and IFX (ρ = -0.729, P = 0.017).
Calprotectin may more accurately discriminate disease activity in RA patients receiving TNFi than acute-phase reactants, even in patients with low inflammatory activity.
比较血清钙卫蛋白与急性期反应物（C反应蛋白[CRP]和红细胞沉降率[ESR]）在接受肿瘤坏死因子抑制剂（TNFi）的类风湿关节炎（RA）患者中对疾病活动度分层的准确性，并将钙卫蛋白水平与TNFi谷浓度血清水平进行关联分析。
我们对87例接受阿达木单抗、依那西普（ETN）或英夫利昔单抗（IFX）治疗的RA患者进行了一项横断面研究；纳入56例银屑病关节炎（PsA）患者和40名健康献血者作为对照。通过相关性分析和线性回归分析钙卫蛋白、CRP和ESR与综合关节指数（28个关节疾病活动评分[DAS28]、简化疾病活动指数[SDAI]和临床疾病活动指数）之间的关联，并通过受试者工作特征曲线（曲线下面积[AUC]）分析钙卫蛋白的准确性和鉴别能力。
钙卫蛋白水平与所有综合活动指数的相关性均优于CRP和ESR（所有r系数>0.70）。与所有关节指数处于低疾病活动度的RA和PsA患者相比，临床缓解期患者的钙卫蛋白水平显著更低。在RA中，仅在使用DAS28时ESR能区分缓解期和低疾病活动度，而CRP仅在使用SDAI时能区分。在缓解期/低疾病活动度的RA患者中，钙卫蛋白而非CRP或ESR能区分无肿胀关节的患者和有≥1个肿胀关节的患者（1.74μg/ml对3.04μg/ml；P = 0.010）。以DAS28≥2.6作为参考变量，钙卫蛋白的AUC为0.92；最佳截断值为≥2.47μg/ml，似然比为6.3（95%置信区间2.5 - 15.8）。钙卫蛋白血清水平与ETN（ρ = -0.671，P < 0.001）和IFX（ρ = -0.729，P = 0.017）的谷浓度血清药物水平呈负相关。
对于接受TNFi治疗的RA患者，即使是炎症活动度较低的患者，钙卫蛋白可能比急性期反应物更准确地鉴别疾病活动度。
Zotero 插件