RESUMO
To compare the diagnostic powers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) in a population selected for its high statistical relevance, over a 6-month period, an informed consent to test for anti-CCP was obtained from 1,025 consecutive patients for whom RF was ordered at a University laboratory. Within 1 year, a diagnosis was obtained without informing the physician about the anti-CCP result. Extensive statistical analyses were performed. A total of 768 patients satisfied the inclusion criteria, and 132 were classified as having RA, yielding a pre-test probability of RA of 17%. The sensitivities for anti-CCP and RF were 62 and 64% (P = 0.83), and the specificities were 97 and 90% (P < 0.001), respectively. The positive predictive value (PPV) was 79% for anti-CCP and 56% for RF (P < 0.001), whereas the negative predictive value was 92% for both. The likelihood ratio (LR) was 17.9 for anti-CCP and 6.2 for RF (P < 0.005). Forty RA patients were diagnosed with RA of less than 2 years length, and the same significant statistic differences between anti-CCP and RF were observed. Placing the results of both tests together, or using different cutoff points, increased the diagnostic utility of the tests. The anti-CCP test has statistically shown significant higher specificity, PPV, and LR for RA than the RF test in a clinically diverse population. If new criteria are to be devised to help diagnose early RA, anti-CCP should be included because it has a greater diagnostic impact than RF.
Assuntos
Anticorpos/química , Artrite Reumatoide/imunologia , Peptídeos Cíclicos/imunologia , Fator Reumatoide/imunologia , Idoso , Artrite Reumatoide/metabolismo , Feminino , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Razão de Chances , Peptídeos Cíclicos/química , Valor Preditivo dos Testes , Probabilidade , Estudos Prospectivos , Fator Reumatoide/química , Sensibilidade e Especificidade , Fatores de TempoAssuntos
Aterosclerose/imunologia , Autoanticorpos/imunologia , Imunoglobulina A/imunologia , beta 2-Glicoproteína I/imunologia , Síndrome Antifosfolipídica/complicações , Aterosclerose/sangue , Aterosclerose/complicações , Autoanticorpos/sangue , Feminino , Humanos , Imunoglobulina A/sangue , MasculinoRESUMO
OBJECTIVE: We sought to measure gallbladder emptying in scleroderma patients, when stimulated by exogenous cholecystokinin. METHODS: Twenty-eight consecutive scleroderma patients were evaluated. Ten were excluded for the presence of gallstones. Gallbladder motor function was studied in 18 patients and 18 controls, using specific parameters for the quantification of gallbladder emptying dynamics. Resting gallbladder volumes were compared using the Dodds method with real-time ultrasound. Cholecystokinin (CCK)-stimulated gallbladder function (0.02 microg/kg CCK intravenous infusion/30 min) was assessed by a scintigraphic technique using 99mTc-DISIDA. Five patients presented with CREST syndrome, 13 with the diffuse form of scleroderma. Four were men, 14 women (average age = 46.6+/-15.4 yr). Patients and controls were paired by gender, age, and weight. RESULTS: Resting gallbladder volumes were larger in the four men with scleroderma than in the women with this disease (p < 0.03, Mann-Whitney). The mean gallbladder resting volume in scleroderma patients was not different from the mean volume detected among controls (p = 0.25), even when controlling for gender (p = 0.78 for women, p = 0.08 for men), scleroderma disease subtype (p = 0.50), or disease duration (p = 0.48). Latency period, ejection period, ejection rate, or ejection fraction as measured during cholecystokinin-stimulated scintigraphic studies were not significantly different between patients and controls. A trend was detected for reduction of the ejection period in scleroderma women (p = 0.70) when compared with scleroderma men. More than 35% of the scleroderma patients presented biliary lithiasis. CONCLUSIONS: There was no significant difference in gallbladder dynamics measured by a scintigraphic technique in scleroderma patients, compared with controls, when gallbladder motor function was evaluated by intravenous CCK.
Assuntos
Esvaziamento da Vesícula Biliar/fisiologia , Escleroderma Sistêmico/fisiopatologia , Adulto , Idoso , Síndrome CREST/diagnóstico , Síndrome CREST/fisiopatologia , Colecistocinina , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Valores de Referência , Escleroderma Sistêmico/diagnóstico , Disofenina Tecnécio Tc 99mRESUMO
The association between depression and altered immunological activities has repeatedly been suggested, but experimental data show contradictory results. In this work, cellular and humoral immunological activities were evaluated in patients presenting major depression, unipolar subtype. Natural killer cell activity (NKCA) was significantly reduced in patients as compared to healthy controls (p < 0.001). However, lymphocyte mitogenic responses and immunoglobulin titers (IgG, IgM, and IgA) were similar for all samples. Hematological, hormonal, and nutritional variables presented normal values in patients and in controls. A familial history of depression was related to lower NKCA and higher phytohemagglutinin responses (p < 0.01). These data suggest possible differential inhibition of cellular immune responses in depressed patients.
Assuntos
Depressão/imunologia , Adulto , Formação de Anticorpos , Divisão Celular , Exercício Físico , Feminino , Hormônios/sangue , Humanos , Imunidade Celular , Imunoglobulinas/sangue , Células Matadoras Naturais/imunologia , Linfócitos/citologia , Linfócitos/efeitos dos fármacos , Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Mitógenos/farmacologia , Estado NutricionalRESUMO
Foram estudadas por meio de imunofluorescencia direta trinta e nove biopsias de pele normal de pacientes portadores de colagenoses. Procuramos observar, em nosso meio a correlacao entre depositos de imunoglobulinas e/ou complemento na juncao dermo-epidermica e o diagnostico de Lupus Eritematoso Sistemico. Foi possivel verificar a alta especificidade e sensibilidade do metodo no diagnostico diferencial dessa colagenose. Concluem os autores ressaltando o importante auxilio no diagnostico que esse procedimento pode proporcionar