Chan Fiona Li Ying, Lester Susan, Whittle Samuel Lawrence, Hill Catherine Louise
The Rheumatology Department, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA 5011 Australia.
BMC Rheumatol. 2019 Apr 10;3:14. doi: 10.1186/s41927-019-0061-z. eCollection 2019.
To compare the utility of ESR, CRP and platelets for the diagnosis of GCA.
A clinical diagnosis of GCA was determined by case-note review of 270 individuals (68% female, mean age 72 years) referred to a central pathology service for a temporal artery biopsy between 2011 and 2014. The highest levels of ESR, CRP and platelets (within 2 weeks of diagnosis) were documented. Evaluation of ESR, CRP and platelets for the diagnosis of GCA were compared using Receiver Operating Characteristic Area Under the Curve (ROC-AUC), and sensitivity/specificity at optimum cut-off values.
GCA was clinically diagnosed in 139 (67%) patients, with 81 TAB positive. The AUC estimates for ESR, CRP and platelets were comparable (0.65 vs 0.72 vs 0.72, = 0.08). The estimated optimal cut-off levels were confirmed at 50 mm/hour for ESR, and determined as 20 mg/L for CRP and 300 × 10/L for platelets. Sensitivity estimates for these three tests were comparable ( = 0.45) and ranged between 66% for ESR and 71% for platelets. Specificity estimates were also comparable ( = 0.11) and ranged between 57% for ESR and 68% for CRP. There was only moderate agreement between the three positive tests (agreement 67%, kappa: 0.34), and when considered collectively, CRP and platelet positive tests were independent predictors of GCA ( < 0.001), but the ESR was not ( = 0.76).
ESR, CRP and platelets are moderate, equivalent diagnostic tests for GCA, but may yield disparate results in individual patients. A combination of CRP and platelet tests may provide the best diagnostic utility for GCA.
比较红细胞沉降率（ESR）、C反应蛋白（CRP）和血小板在巨细胞动脉炎（GCA）诊断中的效用。
通过回顾2011年至2014年间转诊至中央病理科进行颞动脉活检的270例患者（68%为女性，平均年龄72岁）的病历确定GCA的临床诊断。记录ESR、CRP和血小板的最高水平（诊断后2周内）。使用曲线下面积（ROC-AUC）以及最佳临界值时的敏感性/特异性比较ESR、CRP和血小板对GCA的诊断价值。
139例（67%）患者临床诊断为GCA，其中81例颞动脉活检阳性。ESR、CRP和血小板的AUC估计值相当（0.65对0.72对0.72，P = 0.08）。ESR的估计最佳临界值确定为50mm/小时，CRP为20mg/L，血小板为300×10⁹/L。这三项检测的敏感性估计值相当（P = 0.45），ESR为66%，血小板为71%。特异性估计值也相当（P = 0.11），ESR为57%，CRP为68%。三项阳性检测之间仅有中度一致性（一致性为67%，kappa值：0.34），综合考虑时，CRP和血小板阳性检测是GCA的独立预测因素（P < 0.001），但ESR不是（P = 0.76）。
ESR、CRP和血小板是诊断GCA的中等、等效检测方法，但在个体患者中可能产生不同结果。CRP和血小板检测联合使用可能为GCA提供最佳诊断效用。
