METHODS: 45 patients with isolated PMR and 29 patients with PMR/GCA overlap were included. Blood samples were collected before starting glucocorticoids for all patients. Serum biomarkers reflecting systemic inflammation (interleukin-6 (IL-6), CXCL9), vascular remodelling (MMP-2, MMP-3, MMP-9) and endothelial function (sCD141, sCD146, ICAM-1, VCAM-1, vWFA2) were measured by Luminex assays.
RESULTS: Patients with GCA had higher serum levels of sCD141 (p=0.002) and CXCL9 (p=0.002) than isolated PMR. By contrast, serum levels of MMP-3 (p=0.01) and IL-6 (p=0.004) were lower in GCA than isolated PMR. The area under the curve (AUC) was calculated for sCD141, CXCL9, IL-6 and MMP-3. Separately, none of them were >0.7, but combinations revealed higher diagnostic accuracy. The CXCL9/IL-6 ratio was significantly increased in patients with GCA (p=0.0001; cut-off >32.8, AUC 0.76), while the MMP-3/sCD141 ratio was significantly lower in patients with GCA (p<0.0001; cut-off <5.3, AUC 0.79). In patients with subclinical GCA, which is the most difficult to diagnose, sCD141 and MMP-3/sCD141 ratio demonstrated high diagnostic accuracy with AUC of 0.81 and 0.77, respectively.
CONCLUSIONS: Combined serum biomarkers such as CXCL9/IL-6 and MMP-3/sCD141 could help identify GCA in patients with isolated PMR. It could allow to select patients with PMR in whom complementary examinations are needed.
方法:纳入45例孤立PMR患者和29例PMR/GCA重叠患者。在开始所有患者的糖皮质激素之前收集血液样品。反映全身性炎症的血清生物标志物(白细胞介素-6(IL-6),CXCL9),通过Luminex测定法测量血管重塑(MMP-2,MMP-3,MMP-9)和内皮功能(sCD141,sCD146,ICAM-1,VCAM-1,vWFA2)。
结果:GCA患者的血清sCD141(p=0.002)和CXCL9(p=0.002)水平高于分离的PMR。相比之下,GCA中MMP-3(p=0.01)和IL-6(p=0.004)的血清水平低于分离的PMR。计算sCD141、CXCL9、IL-6和MMP-3的曲线下面积(AUC)。分别,两者均不>0.7,但组合显示更高的诊断准确性.CXCL9/IL-6比率在GCA患者中显著增加(p=0.0001;截止值>32.8,AUC0.76),而GCA患者的MMP-3/sCD141比值显着降低(p<0.0001;截止值<5.3,AUC0.79)。在亚临床GCA患者中,这是最难以诊断的,sCD141和MMP-3/sCD141比率显示出高诊断准确性,AUC分别为0.81和0.77。
结论:联合血清生物标志物如CXCL9/IL-6和MMP-3/sCD141可以帮助鉴定孤立PMR患者的GCA。它可以选择需要补充检查的PMR患者。