Department of Rheumatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China.
Department of Rheumatology, Shanxi Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China.
PLoS One. 2021 Feb 2;16(2):e0245612. doi: 10.1371/journal.pone.0245612. eCollection 2021.
Whether the circulating levels of pentraxin 3 (PTX3), an acute phase reactant (APR), are higher in active Takayasu arteritis (TAK), and if so, whether PTX3 is more accurate than C-reactive protein (CRP) in TAK activity assessment has been investigated in this study.
Research works such as PubMed, Embase, ScienceDirect, Cochrane Library, and two Chinese literature databases (CNKI and WanFang) were searched for studies conducted till August 30th, 2019. Two investigators searched the studies independently, who evaluated the quality of the study using the Newcastle-Ottawa scale (NOS) and extracted data. Pooled standard mean difference (SMD) and diagnostic indexes, with a 95% confidence interval (CI), were calculated using a random-effect model.
Totally, 8 studies involving 473 TAK (208 active and 265 inactive TAK) patients and 252 healthy controls were eventually included in the meta-analysis. PTX3 level in the blood in active TAK patients were found to be higher than that in dormant TAK with pooled SMD of 0.761 (95% CI = 0.38-1.14, p<0.0001; I2 = 68%, p of Q test = 0.003). And there was no publication bias. Among the 8 studies, 5 studies identified active TAK with both PTX3 and CRP. The pooled sensitivity, specificity, and AUC values of PTX3 in active TAK diagnosis were higher than those of CRP (0.78 [95% CI = 0.65-0.87] vs. 0.66 [95% CI = 0.53-0.77], p = 0.012; 0.85 [95% CI = 0.77-0.90] vs. 0.77 [95% CI = 0.56-0.90], p = 0.033; 0.88 [95% CI = 0.85-0.90] vs. 0.75 [95% CI = 0.71-0.79], p < 0.0001). It showed potential publication bias using Egger's test (p of PTX3 = 0.031 and p of CRP = 0.047).
PTX3 might be better than CRP in the assessment of TAK activity. Yet, it should be cautious before clinical use for moderate heterogeneity and potential publication bias of the meta-analysis.
本研究旨在探讨急性时相反应物 pentraxin 3（PTX3）在活动期 Takayasu 动脉炎（TAK）患者中的循环水平是否更高，以及 PTX3 在 TAK 活动评估中的准确性是否优于 C 反应蛋白（CRP）。
研究人员检索了截至 2019 年 8 月 30 日发表的PubMed、Embase、ScienceDirect、Cochrane 图书馆和两个中文文献数据库（CNKI 和万方）中的研究。两名研究者独立搜索研究，使用 Newcastle-Ottawa 量表（NOS）评估研究质量，并提取数据。使用随机效应模型计算合并标准均数差（SMD）和诊断指标，置信区间为 95%。
最终共有 8 项研究纳入 473 例 TAK（208 例活动期和 265 例静止期 TAK）患者和 252 例健康对照者。Meta 分析结果显示，活动期 TAK 患者的血液 PTX3 水平明显高于静止期患者，合并 SMD 为 0.761（95% CI = 0.38-1.14，p<0.0001；I2 = 68%，p 值为 Q 检验 = 0.003）。且无发表偏倚。在这 8 项研究中，有 5 项研究同时使用了 PTX3 和 CRP 来确定活动期 TAK。PTX3 在诊断活动期 TAK 方面的敏感性、特异性和 AUC 值均高于 CRP（0.78 [95% CI = 0.65-0.87] 与 0.66 [95% CI = 0.53-0.77]，p = 0.012；0.85 [95% CI = 0.77-0.90] 与 0.77 [95% CI = 0.56-0.90]，p = 0.033；0.88 [95% CI = 0.85-0.90] 与 0.75 [95% CI = 0.71-0.79]，p < 0.0001）。Egger 检验显示，PTX3 存在潜在发表偏倚（p 值为 0.031），而 CRP 则不存在（p 值为 0.047）。
PTX3 可能优于 CRP 用于评估 TAK 活动度。然而，鉴于该研究存在中度异质性和潜在发表偏倚，在临床应用前应谨慎对待。
