检测轴性脊柱关节炎患者 HLA-B27 的两种实验室技术的比较研究:横断面分析。

IF 2 4区 医学 Q3 RHEUMATOLOGY Advances in Rheumatology Pub Date : 2024-05-23 DOI:10.1186/s42358-024-00383-x
Ricardo Dos Santos Angeli, André Lucas Ribeiro, Charles Lubianca Kohem, Ricardo Machado Xavier, Odirlei André Monticielo
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引用次数: 0

摘要

背景:人类白细胞抗原B-27(HLA-B27)在轴性脊柱关节炎(AxSpA)中的诊断和预后意义毋庸置疑,70%的强直性脊柱炎(AS)患者携带B27基因,而普通人群中仅有4.35%携带该基因。流式细胞术(FC)和聚合酶链式反应(PCR)已成为常规 HLA-B27 分型的主要技术。虽然已有多项研究对这些方法进行了比较,但没有一项研究符合巴西人口的独特特征。因此,本研究旨在对巴西确诊为 AxSpA 的人群中的 FC 和 PCR 进行比较:一项分析性横断面研究涉及巴西一所大学医院的62名AxSpA门诊患者。研究采用FC和PCR-SSP两种检测方法确定HLA-B27分型。研究结果(证实或否定等位基因的存在)均经过严格审查。使用卡帕统计量评估了两种方法之间的一致性。结果的 p 值为根据 FC 方法,90.3%(n = 56)的参与者 HLA-B27 呈阳性,而使用 PCR 方法,79%(n = 49)的参与者 HLA-B27 呈阳性。FC 的灵敏度为 98%,特异性为 38.5%。FC 的阳性预测值为 85.7%,阴性预测值为 83.5%。因此,FC 方法的总体准确率为 85.5%。卡帕系数为 κ = 0.454:FC在HLA-B27检测中表现出显著的灵敏度和令人满意的准确性,尽管与PCR-SSP相比特异性有所降低。尽管如此,鉴于其相对于 PCR 的成本效益和简化操作,FC 仍是临床实践中初步筛查的实用选择,尤其是在低收入地区。为了优化资源分配,我们主张采用一种改进的算法,首先根据 Choosing Wisely 的建议评估 HLA-B27 分型的相关性。然后进行 FC 检测,如果结果为阴性,但临床怀疑仍然存在,则进行 PCR 检测。这种方法旨在平衡诊断准确性和财务谨慎性,尤其是在医疗成本不断攀升的地区。
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Comparative study of two laboratory techniques for the detection of HLA-B27 in patients with axial spondyloarthritis: a cross-sectional analysis.

Background: The diagnostic and prognostic relevance of Human Leukocyte Antigen B-27 (HLA-B27) in Axial Spondyloarthritis (AxSpA) is undeniable, with 70% of Ankylosing Spondylitis (AS) patients carrying the B27 gene, contrasted with a mere 4.35% in the general population. Flow cytometry (FC) and Polymerase Chain Reaction (PCR) have emerged as the predominant techniques for routine HLA-B27 typing. While various studies have compared these methods, none have catered to the unique characteristics of the Brazilian demographic. Therefore, this research aims to compare FC and PCR in a Brazilian cohort diagnosed with AxSpA.

Methods: An analytical cross-sectional study was undertaken involving 62 AxSpA outpatients from a Brazilian University Hospital. Both FC and PCR-SSP assays were utilized to ascertain HLA-B27 typing. The outcomes (either confirming or refuting the allele's presence) underwent rigorous scrutiny. Agreement between the methodologies was assessed using the kappa statistic. A p-value of < 0.05 was deemed statistically significant.

Results: Of the participants, 90.3% (n = 56) were HLA-B27 positive according to FC, while 79% (n = 49) were identified as positive using the PCR method. FC exhibited a sensitivity rate of 98% paired with a specificity of 38.5%. The Positive Predictive Value for FC stood at 85.7%, and the Negative Predictive Value was 83.5%. Consequently, the overall accuracy of the FC method was gauged at 85.5%. A kappa coefficient of κ = 0.454 was derived.

Conclusions: FC demonstrated noteworthy sensitivity and satisfactory accuracy in HLA-B27 detection, albeit with a reduced specificity when contrasted with PCR-SSP. Nevertheless, given its cost-effectiveness and streamlined operation relative to PCR, FC remains a pragmatic option for preliminary screening in clinical practice, especially in low-income regions. To optimize resource allocation, we advocate for a refined algorithm that initiates by assessing the relevance of HLA-B27 typing based on Choosing Wisely recommendations. It then leans on FC, and, if results are negative yet clinical suspicion persists, advances to PCR. This approach aims to balance diagnostic accuracy and financial prudence, particularly in regions contending with escalating medical costs.

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来源期刊
Advances in Rheumatology
Advances in Rheumatology Medicine-Rheumatology
CiteScore
4.00
自引率
4.30%
发文量
41
审稿时长
53 weeks
期刊介绍: Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.
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