Abstract：
BACKGROUND: Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are frequently overlapping conditions. Unlike in GCA, vascular inflammation is absent in PMR. Therefore, serum biomarkers reflecting vascular remodelling could be used to identify GCA in cases of apparently isolated PMR.
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.
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.
摘要：
背景：风湿性多肌痛（PMR）和巨细胞动脉炎（GCA）经常重叠。与GCA不同,PMR中不存在血管炎症。因此,反映血管重塑的血清生物标志物可用于在明显孤立的PMR病例中鉴定GCA。
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。
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。
