Departments of Rheumatology, Nuclear Medicine and Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia.
Department of Rheumatology, Prince of Wales Hospital, Sydney, NSW, Australia.
Int J Rheum Dis. 2021 Jun;24(6):781-788. doi: 10.1111/1756-185X.14111. Epub 2021 Apr 13.
Diagnosing and monitoring vascular activity in giant cell arteritis (GCA) is difficult due to the paucity of specific serological biomarkers. We assessed the utility of 8 novel biomarkers in an inception cohort of newly suspected GCA patients.
Consecutive patients were enrolled between May 2016 and December 2017. Serum was collected within 72 hours of commencing corticosteroids and at 6 months. It was analyzed for levels of intra-cellular adhesion molecule 1, vascular endothelial growth factor (VEGF), pentraxin 3, von Willebrand factor and procalcitonin (5-plex R&D Systems multiplex assay) and interleukin (IL)6, IL12 and interferon-γ (high-sensitivity 3-plex ProcartaPlex multiplex assay). A GCA specific positron emission tomography / computed tomography (PET/CT) scan was performed at enrolment with uptake in each vascular territory graded and summed to derive a total vascular score (TVS).
For the 63 patients enrolled, 12 (19%) had a final diagnosis of biopsy-positive GCA and a further 9 had a clinical diagnosis of biopsy-negative GCA. None of the 8 biomarkers was significantly higher in GCA patients compared with those with alternative diagnoses, or demonstrated a positive correlation with the PET/CT TVS. This was in contrast to the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) which were higher in the biopsy-positive GCA cohort (P < .04) and showed weak positive correlations with the TVS (correlation coefficient 0.34, P < .01). Procalcitonin did not distinguish between GCA and infection. Concentrations of CRP, ESR, VEGF and pentraxin 3 decreased between diagnosis and 6 months in GCA patients.
This study did not identify new serological biomarkers to assist in diagnosing or assessing the vasculitis burden in GCA.
由于缺乏特异性的血清学标志物，巨细胞动脉炎（GCA）的血管活性诊断和监测较为困难。我们评估了 8 种新型生物标志物在新确诊的 GCA 患者中的应用价值。
连续入组 2016 年 5 月至 2017 年 12 月间新诊断的 GCA 患者。在开始使用皮质激素的 72 小时内和 6 个月时采集血清。采用 5 聚体 R&D 系统多指标检测试剂盒检测细胞间黏附分子 1、血管内皮生长因子（VEGF）、五聚素 3、血管性血友病因子和降钙素原水平，采用高灵敏度 3 聚体 ProcartaPlex 多指标检测试剂盒检测白细胞介素（IL）6、IL12 和干扰素-γ水平。所有患者在入组时均行 GCA 特异性正电子发射断层扫描/计算机断层扫描（PET/CT）检查，对每个血管区域的摄取情况进行评分，并将所有血管区域的评分相加得到总的血管评分（TVS）。
共入组 63 例患者，其中 12 例（19%）最终诊断为活检阳性的 GCA，9 例（14%）为活检阴性的 GCA。与其他诊断相比，GCA 患者的 8 种生物标志物水平均无明显升高，或与 PET/CT TVS 无明显正相关，这与 C 反应蛋白（CRP）和红细胞沉降率（ESR）形成鲜明对比，后者在活检阳性的 GCA 患者中更高（P＜0.04），且与 TVS 呈弱正相关（相关系数 0.34，P＜0.01）。降钙素原不能区分 GCA 和感染。GCA 患者的 CRP、ESR、VEGF 和五聚素 3 浓度在诊断时和 6 个月时均下降。
本研究未发现新的血清学标志物来辅助 GCA 的诊断或评估血管炎负担。
