El-Sherif Wafaa T, Nigm Dalia A, Abd-Elsamea Mona H, Kassem Alaa M
Department of Clinical Pathology & Physical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Rheumatology & Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt.
Egypt J Immunol. 2019 Jan;26(1):163-175.
Rheumatoid arthritis (RA) is one of the most common systemic autoimmune diseases. New markers are needed for early diagnosis of RA as seronegativity in both early and established RA remains a major limitation of both anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF). The 14-3-3η protein may represent a novel biomarker for the detection of RA. We evaluated the diagnostic performance of serum 14-3-3η protein in early and established cases of rheumatoid arthritis and we compared the diagnostic accuracy of it with those of the well-known RA markers (e.g. RF and ACPA). Sera from 50 patients with RA (20 early and 30 established) based on the 2010 ACR / EULAR Rheumatoid Arthritis Classification Criteria, 15 patients with non-RA arthritis as diseases control group (8 patients with OA and 7 patients with SLE) and 14 healthy controls were enrolled in the study. Serum RF was determined by latex, ACPA and 14-3-3η protein were determined by ELISA. Serum 14-3-3η protein levels in patients with RA were significantly higher (P=0.001*) as compared to healthy individuals. For serum 14-3-3η diagnostic accuracy in RA; Receiver operating characteristic curves (ROC) analysis comparing patient with RA with healthy control showed AUC (0.916) at optimum cutoff of > 2.5ng/mL, and a sensitivity of 100%, a specificity of 78.57%, a PPV of 94.3, and an NPV of 100. No significant difference in 14-3-3η protein serum levels was found between early and established RA groups. It was positive in 100% of early and established RA patients who were seronegative for RF and ACPA. It is concluded that, 14-3-3η protein could improve the sensitivity of RA diagnosis and cover the shortage of detection of RF and ACPA in RA patients.
类风湿关节炎(RA)是最常见的全身性自身免疫性疾病之一。由于早期和确诊的RA患者血清学阴性仍然是抗瓜氨酸化蛋白抗体(ACPA)和类风湿因子(RF)检测的主要局限性,因此需要新的标志物用于RA的早期诊断。14-3-3η蛋白可能是一种用于检测RA的新型生物标志物。我们评估了血清14-3-3η蛋白在早期和确诊类风湿关节炎病例中的诊断性能,并将其诊断准确性与已知的RA标志物(如RF和ACPA)进行了比较。根据2010年美国风湿病学会(ACR)/欧洲抗风湿病联盟(EULAR)类风湿关节炎分类标准,选取50例RA患者(20例早期患者和30例确诊患者)、15例非RA关节炎患者作为疾病对照组(8例骨关节炎患者和7例系统性红斑狼疮患者)以及14例健康对照者纳入本研究。血清RF采用乳胶法检测,ACPA和14-3-3η蛋白采用酶联免疫吸附测定(ELISA)法检测。与健康个体相比,RA患者血清14-3-3η蛋白水平显著升高(P = 0.001*)。对于血清14-3-3η蛋白在RA中的诊断准确性;将RA患者与健康对照者进行比较的受试者工作特征曲线(ROC)分析显示,在最佳临界值>2.5ng/mL时,曲线下面积(AUC)为0.916,灵敏度为100%,特异性为78.57%,阳性预测值(PPV)为94.3,阴性预测值(NPV)为100。早期和确诊RA组之间未发现14-3-3η蛋白血清水平有显著差异。在RF和ACPA血清学阴性的早期和确诊RA患者中,其阳性率为100%。结论是,14-3-3η蛋白可提高RA诊断的灵敏度,并弥补RA患者中RF和ACPA检测的不足。