Turina Maureen C, Yeremenko Nataliya, van Gaalen Floris, van Oosterhout Maikel, Berg Inger J, Ramonda Ramona, Lebre Cristina M C, Landewé Robert, Baeten Dominique
Department of Clinical Immunology and Rheumatology , Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands.
Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Immunology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
RMD Open. 2017 Jan 11;3(1):e000319. doi: 10.1136/rmdopen-2016-000319. eCollection 2017.
Decreasing the diagnostic delay in axial spondyloarthritis (axSpA) remains a major challenge. Here, we assessed the value of serum inflammatory biomarkers to distinguish early axSpA from other pathologies in a large cohort of patients referred with early back pain.
Serum c reactive protein (CRP), erythrocyte sedimentation rate (ESR) and calprotectin were determined in the SPondyloArthritis Caught Early (SPACE) cohort (n=310), an early back pain inception cohort. Additionally, explorative serum biomarkers derived from the literature (interleukin-27 (IL-27), human β-defensin-2 (hBD-2) and lipcolin-2 (LCN-2)) were determined by ELISA in full-blown patients with ankylosing spondylitis (AS) (n=21) and healthy controls (n=20).
Serum CRP and ESR levels were not elevated in early axSpA versus 'control' back pain patients. Serum calprotectin was elevated in early axSpA versus controls (p=0.01) but failed to identify early axSpA at the individual level (positive predictive value of 38.7%). As to explorative biomarkers, serum levels of IL-27 were not detectable, and hBD-2 and LCN-2 serum levels were not elevated in full-blown AS versus healthy controls (p=0.572, p=0.562, respectively). Therefore, these markers were not further determined in the SPACE cohort.
None of the candidate serum inflammatory markers were useful as diagnostic markers in the early phase of axSpA.
缩短轴性脊柱关节炎（axSpA）的诊断延迟仍然是一项重大挑战。在此，我们评估了血清炎症生物标志物在一大群因早期背痛就诊的患者中区分早期axSpA与其他病症的价值。
在早期背痛起始队列“早期发现脊柱关节炎（SPACE）队列”（n = 310）中测定血清C反应蛋白（CRP）、红细胞沉降率（ESR）和钙卫蛋白。此外，通过酶联免疫吸附测定法（ELISA）在强直性脊柱炎（AS）确诊患者（n = 21）和健康对照者（n = 20）中测定从文献中获取的探索性血清生物标志物（白细胞介素-27（IL-27）、人β-防御素-2（hBD-2）和脂质运载蛋白-2（LCN-2））。
与“对照”背痛患者相比，早期axSpA患者的血清CRP和ESR水平未升高。与对照组相比，早期axSpA患者的血清钙卫蛋白升高（p = 0.01），但在个体水平上未能识别出早期axSpA（阳性预测值为38.7%）。至于探索性生物标志物，在强直性脊柱炎确诊患者中未检测到IL-27的血清水平，与健康对照者相比，hBD-2和LCN-2的血清水平未升高（分别为p = 0.572，p = 0.562）。因此，这些标志物未在SPACE队列中进一步测定。
在axSpA的早期阶段，没有一种候选血清炎症标志物可作为诊断标志物。
