標(biāo)簽:?類風(fēng)濕關(guān)節(jié)炎; 抗CCP抗體; 預(yù)測(cè)因子; 病程演變

在總?cè)巳褐斜O(jiān)測(cè)ACPA能否預(yù)測(cè)早期關(guān)節(jié)炎

Verstappen SM, et al. EULAR 2015. Present ID: OP0268.

背景：ACPA免疫應(yīng)答常常先于RA診斷數(shù)年, 鮮有研究比較正常人群的ACPA與已發(fā)展為RA或炎性多關(guān)節(jié)炎(IP)人群中的ACPA。

目的：正常人群ACPA狀態(tài)與將來發(fā)展RA或炎性多關(guān)節(jié)炎(IP)人群的ACPA狀態(tài)進(jìn)行比較。

方法：用ELISA方法檢測(cè)ACPA(歐洲D(zhuǎn)iagnostica公司)。基線時(shí)的血清樣本來自在英國(guó)諾福克進(jìn)行的歐洲癌癥前瞻性調(diào)查研究(EPIC-Norfolk)隊(duì)列。此外, 資料包括ACPA狀態(tài)(>25U /mL為陽性)、年齡、性別、社會(huì)經(jīng)濟(jì)地位(如手工/非技術(shù)熟練的工人, 經(jīng)理/技術(shù)熟練的非體力勞動(dòng)者, 專業(yè)人員)和吸煙狀況(從未吸煙、曾經(jīng)和現(xiàn)在)。這個(gè)人群中若有發(fā)展為IP/RA的患者, 將通過諾福克關(guān)節(jié)炎注冊(cè)登記中心(NOAR, 英國(guó)一個(gè)基于初級(jí)保健的隊(duì)列)而被找到。用邏輯回歸分析評(píng)估總?cè)巳旱娜丝诮y(tǒng)計(jì)特征是否與ACPA+的關(guān)聯(lián), 校正年齡和性別后用Cox回歸分析評(píng)估ACPA與IP之間的關(guān)聯(lián)性。在EPIC-Norfolk隊(duì)列登記注冊(cè)時(shí)已經(jīng)有關(guān)節(jié)炎癥狀的患者將不被納入本次Cox回歸分析(N= 104)。此外, 還分析了ACPA與吸煙之間的相互作用。隨訪患者直至出現(xiàn)以下任何一種情況, 他/她們發(fā)展為IP/RA, 或截尾至死亡或2014年5月。

結(jié)果：18628例EPIC參與者基線時(shí)檢測(cè)了ACPA, 年齡為40-79歲。EPIC人群中有429例(2.30％)ACPA陽性者。EPIC人群中有104例在注冊(cè)時(shí)已是IP/RA患者(35.6％ ACPA+, 滴度中位數(shù)6.95 [IQR: 3.75 -121.2])。在311051病人年隨訪過程中中, 173人發(fā)展為IP。

橫斷面分析顯示, 曾經(jīng)吸煙和現(xiàn)在吸煙分別與ACPA+呈正相關(guān)(OR: 1.60, 95％CI: 1.95-2.13; OR: 1.29, 95％CI:1.02-1.55), 年齡與ACPA+相關(guān)(OR: 1.01, 95％CI: 1.00-1.03)。患者性別、社會(huì)地位與ACPA無關(guān)。上述173例在隨訪過程中發(fā)展為IP, 并在NOAR注冊(cè)登記, 其中85例(49.4％)符合2010年ACR/EULAR分類標(biāo)準(zhǔn)。基線ACPA檢測(cè)結(jié)果是發(fā)展為IP/RA的預(yù)測(cè)因素(校正HR: 10.3, 95%CI: 6.90-15.34)。ACPA與吸煙之間的交互作用不明顯。

結(jié)論：40至79歲的總?cè)巳簶颖局蠥CPA陽性率為2.1％。ACPA陽性者在3至10年后發(fā)展為IP/ RA的可能性是ACPA陰性者的10倍。ACPA聯(lián)合其它檢查可有效地找到IP/RA高風(fēng)險(xiǎn)人群。

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原文鏈接或參見以下信息。

Ann Rheum Dis?2015;74:173?doi:10.1136/annrheumdis-2015-eular.4793

• Oral Presentations

OP0268?Anti-Citrullinated Protein Antibody (ACPA) Status in the General Population and as a Predictor of Future Inflammatory Polyarthritis: The EPIC-2-Noar Study

S.M. Verstappen¹,?

J.C. Sergeant²,?

R.N. Luben³,?

A. Bhaniani³,?

S. Anuj³,?

A. MacGregor⁴,

N. Wareham³,?

D.P. Symmons^1,2,?

K.T. Khaw³,?

I.N. Bruce^1,2?

on behalf of RA-MAP consortium

-Author Affiliations

¹Arthritis Research UK Centre for Epidemiology, The University of Manchester

²NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester

³European Prospective Investigation into Cancer and Nutrition,?Department of Public Health and Primary Care, Cambridge

⁴Norfolk and Norwich University Hospital, Norwich, United Kingdom

Abstract

? ? ? ? ? ?

Background?Anti-citrullinated protein antibody (ACPA) immune response occurs several years prior to the diagnosis of rheumatoid arthritis (RA). However, limited data are available on ACPA status in the general population compared to those who develop RA or inflammatory polyarthritis (IP) in the future.

Objectives?The aim of this study was to examine ACPA status in the general population and in patients developing IP/RA.

Methods?ACPA was measured by ELISA (Euro-Diagnostica) in stored serum samples collected at baseline in people participating in the European Prospective Investigation of Cancer in Norfolk, (EPIC-Norfolk), a prospective population-based study in the UK. In addition, data on ACPA status (positive >25 U/ml) age, gender, socio-economic status (i.e. manual/unskilled worker, manager/skilled non-manual worker, professional), smoking status (i.e. never, former, current) were also collected at inclusion. Individuals who subsequently developed IP/RA were identified by linkage with the Norfolk Arthritis Register (NOAR), a primary-care based cohort with an overlapping catchment area in the UK. Logistic regression analyses were used to assess the association between demographic characteristics and ACPA positivity in the general population. Cox regression analyses were performed to assess the association between ACPA and the development of IP, adjusting for age and gender. Patients with a symptom onset prior to inclusion in EPIC-Norfolk were excluded from the Cox regression analysis (N=104). In addition, the interaction between ACPA and smoking was tested. People were followed until development of IP/RA or censored at date of death or May 2014, whichever came first.

Results?ACPA was measured in 18,628 EPIC participants aged 40-79 years. ACPA was positive in 429 subjects (2.30%) of the whole EPIC population including 104 patients with prevalent IP/RA (35.6% ACPA positive, median titre 6.95 [IQR 3.75 – 121.2] U/ml) and 173 (16.8% ACPA positive, median titre 5.14 [IQR 3.37 – 9.41] U/ml) subjects who developed IP during 311,051 person years of follow-up. Cross-sectionally, current and former smokers (OR 1.60, 95%CI 1.95 to 2.13 and OR 1.29 95%CI 1.02 to 1.55, respectively) and older age (OR 1.01 95%CI 1.00 to 1.03) were associated with ACPA positivity. Gender and socio-economic status were not associated with ACPA. Of 173 patients who developed IP and were notified to NOAR, 85 (49.4%) fulfilled the 2010 ACR/EULAR criteria for RA at entry to the NOAR cohort. ACPA status was predictive for the development of IP/RA (adjHR 10,3 95%CI 6.90 to 15.34). The interaction between ACPA and smoking was not significant.

Conclusions?ACPA was positive in 2.1% of a general population sample aged 40-79 years old. People who were ACPA positive were 10 times more likely to develop IP/RA in the next 3-10 years than those ACPA negative subjects. ACPA may be a useful adjunct to other screening approaches to identify people at higher risk of developing IP/RA.

轉(zhuǎn)載于:https://www.cnblogs.com/T2T4RD/p/5464155.html

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