抗瓜氨酸化肽抗体在系统性硬化症中的意义：频率和 Meta 分析。

Anti-citrullinated peptides antibodies in systemic sclerosis: Meta-analysis of frequency and meaning.

机构信息

Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France.

Centre de rhumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Dr-Baylac, TSA 40 031, 31059 Toulouse cedex 9, France; Pharmaco-épidémiologie, évaluation de l'utilisation et du risque médicamenteux, Inserm UMR 1027, faculté de médecine, 37, allées Jules-Guesde, 31000 Toulouse, France.

出版信息

Joint Bone Spine. 2018 Mar;85(2):147-153. doi: 10.1016/j.jbspin.2017.11.006. Epub 2017 Nov 26.

DOI:10.1016/j.jbspin.2017.11.006

PMID:29183860

Abstract

OBJECTIVES

Diagnosis of systemic sclerosis (SSc) is partially determined by the presence of specific autoantibodies often associated with specific clinical features. Recent studies report the presence of ACPA in SSc. We aimed to evaluate the prevalence of ACPA in SSc and to assess their influence on clinical presentation of SSc.

METHODS

A systematic literature search was performed using PubMed and Cochrane databases' publications between 1999 and March 2017. Search terms were: "systemic sclerosis [MeSH] AND (ACPA OR anti-CCP OR rheumatoid factor OR cohort OR value diagnostic)". In a first step, we selected cohorts with >50 SSc patients with ACPA identification, for ACPA frequency determination. In a second step, we included studies that analysed clinical profiles according to ACPA status. Meta-analyses were performed when at least two studies were available.

RESULTS

First, we identified 13 observational studies with a total of 1231 SSc patients. The mean prevalence of ACPA in SSc was 9.2%. Secondly, we identified nine studies reporting clinical aspects according to ACPA status. Our meta-analyses showed a significant association between ACPA positivity and the presence of arthritis (odds ratio (OR)=22.48 [10.71-47.21]), joint erosions seen on X-rays (OR=14.79 [6.38-34.28]), pulmonary fibrosis (OR=2.75 [1.21-6.24]), oesophagus involvement (OR=2.72 [1.05-7.07]), and diffuse skin involvement (OR=2.21 [1.21-4.03]).

CONCLUSIONS

The prevalence of ACPA in scleroderma is 9.2%. Our meta-analysis shows an increased risk for erosive arthritis, pulmonary fibrosis, oesophagus involvement and diffuse skin involvement, in patients with ACPA-positive SSc. ACPA should be systematically included in SSc assessment.

摘要

目的

系统性硬化症（SSc）的诊断部分取决于特定自身抗体的存在，这些自身抗体通常与特定的临床特征相关。最近的研究报告了 SSc 中存在 ACPA。我们旨在评估 SSc 中 ACPA 的患病率，并评估其对 SSc 临床表现的影响。

方法

使用 PubMed 和 Cochrane 数据库的出版物进行了系统的文献检索，检索时间为 1999 年至 2017 年 3 月。检索词为：“systemic sclerosis [MeSH] AND (ACPA OR anti-CCP OR rheumatoid factor OR cohort OR value diagnostic)”。在第一步中，我们选择了有>50 例 SSc 患者具有 ACPA 鉴定的队列，以确定 ACPA 的频率。在第二步中，我们纳入了根据 ACPA 状态分析临床特征的研究。当有至少两项研究时进行荟萃分析。

结果

首先，我们确定了 13 项观察性研究，共有 1231 例 SSc 患者。SSc 中 ACPA 的平均患病率为 9.2%。其次，我们确定了 9 项报告了根据 ACPA 状态的临床方面的研究。我们的荟萃分析显示，ACPA 阳性与关节炎（优势比（OR）=22.48 [10.71-47.21]）、X 射线显示的关节侵蚀（OR=14.79 [6.38-34.28]）、肺纤维化（OR=2.75 [1.21-6.24]）、食管受累（OR=2.72 [1.05-7.07]）和弥漫性皮肤受累（OR=2.21 [1.21-4.03]）之间存在显著相关性。