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Abstract
AimsWhether the circulating levels of pentraxin 3 (PTX3), an acute phase reactant (APR), are higher in active Takayasu arteritis (TAK), and if so, whether PTX3 is more accurate than C-reactive protein (CRP) in TAK activity assessment has been investigated in this study.Study designResearch works such as PubMed, Embase, ScienceDirect, Cochrane Library, and two Chinese literature databases (CNKI and WanFang) were searched for studies conducted till August 30th, 2019. Two investigators searched the studies independently, who evaluated the quality of the study using the Newcastle–Ottawa scale (NOS) and extracted data. Pooled standard mean difference (SMD) and diagnostic indexes, with a 95% confidence interval (CI), were calculated using a random-effect model.ResultsTotally, 8 studies involving 473 TAK (208 active and 265 inactive TAK) patients and 252 healthy controls were eventually included in the meta-analysis. PTX3 level in the blood in active TAK patients were found to be higher than that in dormant TAK with pooled SMD of 0.761 (95% CI = 0.38–1.14, p<0.0001; I2 = 68%, p of Q test = 0.003). And there was no publication bias. Among the 8 studies, 5 studies identified active TAK with both PTX3 and CRP. The pooled sensitivity, specificity, and AUC values of PTX3 in active TAK diagnosis were higher than those of CRP (0.78 [95% CI = 0.65–0.87] vs. 0.66 [95% CI = 0.53–0.77], p = 0.012; 0.85 [95% CI = 0.77–0.90] vs. 0.77 [95% CI = 0.56–0.90], p = 0.033; 0.88 [95% CI = 0.85–0.90] vs. 0.75 [95% CI = 0.71–0.79], p < 0.0001). It showed potential publication bias using Egger’s test (p of PTX3 = 0.031 and p of CRP = 0.047).ConclusionsPTX3 might be better than CRP in the assessment of TAK activity. Yet, it should be cautious before clinical use for moderate heterogeneity and potential publication bias of the meta-analysis.
Highlights
Takayasu arteritis (TAK) is a large-vessel vasculitis, predominantly involving the aorta and its major branches, and causes stenosis of the vessel and ischemic syndrome [1]
Pentraxin 3 (PTX3) level in the blood in active TAK patients were found to be higher than that in dormant TAK with pooled standard mean difference (SMD) of 0.761
The pooled sensitivity, specificity, and area under the curve (AUC) values of PTX3 in active TAK diagnosis were higher than those of C-reactive protein (CRP) (0.78 [95% confidence interval (CI) = 0.65–0.87] vs. 0.66 [95% confidence interval (95% CI) = 0.53–0.77], p = 0.012; 0.85 [95% CI = 0.77–0.90] vs. 0.77 [95% CI = 0.56–0.90], p = 0.033; 0.88 [95% CI = 0.85–0.90] vs. 0.75 [95% CI = 0.71–0.79], p < 0.0001)
Summary
Takayasu arteritis (TAK) is a large-vessel vasculitis, predominantly involving the aorta and its major branches, and causes stenosis of the vessel and ischemic syndrome [1]. C-reactive protein (CRP), an acute-phase reactant (APR), is frequently used besides erythrocyte sedimentation rate (ESR) for monitoring the disease activity of TAK. PTX3 levels that were evaluated in vessels were reported to be involved in rheumatological diseases such as systemic lupus erythematosus [4] and rheumatoid arthritis [5], and in vasculitis such as small vessel vasculitis [6] and giant cell arteritis [7]. PTX3 levels in blood were identified in the tissues of patients with an aortic aneurysm, even in the vessel wall of vasa vasorum [8, 9], from which inflammatory lesions originate in TAK [10]. All the above information indicates that PTX3 may be a biomarker for disease activity in TAK patients. Contradictory results have been shown in the studies by Tombetti et al and AlibazOner et al [11, 12]
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