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Titolo:
Diagnostic performance of antineutrophil cytoplasmic antibody tests for idiopathic vasculitides: Metaanalysis with a focus on antimyeloperoxidase antibodies
Autore:
Choi, HK; Liu, SM; Merkel, PA; Colditz, GA; Niles, JL;
Indirizzi:
Massachusetts Gen Hosp, Arthrit Unit, Dept Med, Boston, MA 02114 USA Massachusetts Gen Hosp Boston MA USA 02114 Dept Med, Boston, MA 02114 USA Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 th, Dept Epidemiol, Boston, MA 02115 USA Boston Univ, Sch Med, Dept Med, Arthrit Ctr, Boston, MA USA Boston Univ Boston MA USA Sch Med, Dept Med, Arthrit Ctr, Boston, MA USA Massachusetts Gen Hosp, Dept Med, Renal Unit, Boston, MA 02114 USA Massachusetts Gen Hosp Boston MA USA 02114 nal Unit, Boston, MA 02114 USA
Titolo Testata:
JOURNAL OF RHEUMATOLOGY
fascicolo: 7, volume: 28, anno: 2001,
pagine: 1584 - 1590
SICI:
0315-162X(200107)28:7<1584:DPOACA>2.0.ZU;2-L
Fonte:
ISI
Lingua:
ENG
Soggetto:
RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; WEGENERS-GRANULOMATOSIS; GBM ANTIBODIES; C-ANCA; AUTOANTIBODIES; PREVALENCE; SEROLOGY;
Keywords:
antineutrophil cytoplasmic antibody; antiproteinase 3; antimyeloperoxidase; Wegener's granulomatgsis; microscopic polyangiitis; Churg-Strauss syndrome; idiopathic necotizing crescentic glomerulonephritis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Choi, HK Massachusetts Gen Hosp, Arthrit Unit, Dept Med, Bulfinch 165,Fruit St, Boston, MA 02114 USA Massachusetts Gen Hosp Bulfinch 165,Fruit St Boston MA USA 02114
Citazione:
H.K. Choi et al., "Diagnostic performance of antineutrophil cytoplasmic antibody tests for idiopathic vasculitides: Metaanalysis with a focus on antimyeloperoxidase antibodies", J RHEUMATOL, 28(7), 2001, pp. 1584-1590

Abstract

Objective. The diagnostic value of tests for antimyeloperoxidase antibodies (anti-MPO) for systemic vasculitis is less established than that for cytoplasmic antineutrophil cytoplasmic antibody (cANCA)/antiproteinase 3 antibodies (anti-PR3). Controversy exists regarding the optimal utilization of indirect immunofluorescence (IIF) ANCA testing versus antigen-specific ANCA testing. To summarize the pertinent data, we conducted a metaanalysis examining the diagnostic value of ANCA testing systems that include assays for anti-MPO,Methods. We performed a structured Medline search and reference list review. Target articles in the search strategy were those reporting the diagnostic value of immunoassays for anti-MPO for the spectrum of systemic necrotizing vasculitides that includes Wegener's granulomatosis, microscopic polyangiitis, the Churg-Strauss syndrome, and isolated pauci-immune necrotizing or crescentic glomerulonephritis, regardless of other types of ANCA tests. Inclusion criteria required specification of a consecutive or random patientselection method and the use of acceptable criteria for the diagnosis of vasculitis exclusive of ANCA test results. Weighted pooled summary estimatesof sensitivity and specificity were calculated for anti-MPO alone, anti-MPO + perinuclear ANCA (pANCA), and anti-MPO/pANCA + anti-PR3/cANCA. Results, Of 457 articles reviewed, only 7 met the selection criteria, Summary estimates of sensitivity and specificity (against disease controls only) of assays for anti-MPO for the diagnosis of systemic necrotizing vasculitides were 37.1% (confidence interval 26.6% to 47.6%) and 96.3% (CI 94.1% to98.5%), respectively. When the pANCA pattern by IIF was combined with anti-MPO testing, the specificity improved to 99.4%, with a lower sensitivity, 31.5%. The combined ANCA testing system (anti-PR3/cANCA + anti-MPO/pANCA) increased the sensitivity to 85.5% with a specificity of 98.6%,Conclusion. These results suggest that while anti-MPO is relatively specific for the diagnosis of systemic vasculitis, the combination system of immunoassays for anti-MPO and IIF for pANCA is highly specific and both tests should be used together given the high diagnostic precision required for these conditions. Because patients with ANCA associated vasculitis have eitheranti-MPO with pANCA or anti-PR3 with cANCA, and rarely both, a combined ANCA testing system including anti-PR3/cANCA and anti-MPO/pANCA is recommended to optimize the diagnostic performance of ANCA testing.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/12/20 alle ore 08:25:56