Clinical value of determining the markers of vascular wall damage in patients with ANCA-associated vasculitis and polyarteritis nodosa
Keywords:systemic vasculitis, ANCA-associated vasculitis, polyarteritis nodosa, biomarkers, diagnosis, endothelin-1, alpha-actin-2, elastin
The aim of the study – to determine the diagnostic value of serum levels of endothelin-1, alpha-actin-2 and elastin in patients with primary systemic vasculitis.Materials and methods. Twenty eight patients with ANCA-associated vasculitis, 8 patients with polyarteritis nodosa of moderate or high vasculitis activity (BVAS >11) and 26 healthy subjects (control group) were examined. Serum levels of endothelin-1, alpha-actin-2 and elastin were determined by immunoassay using commercial kits of Biomedica, Biorbyt and Bender Medsystems.
Results. The level of endothelin-1 in patients with primary systemic vasculitis did not significantly differ from that of the control group, but its level (0.40 ± 0.33 pmol/l) was significantly higher in patients with kidney involvement (n = 15) compared with patients without kidney damage (0.28 ± 0.22 pmol/l, P = 0.04) and the control group (0.27 ± 0.10 pmol/l, P < 0.01). The level of alpha-actin-2 in the group of patients with ANCA-associated vasculitis was twice as high as in the control group (P < 0.05), which can be used for diagnosis this group of diseases (AUC 0.96 ± 0.16; 95 % CI 0.60–1.00; sensitivity 83 %, specificity 84 %, P <0.01). The level of elastin in the group of patients with polyarteritis nodosa was significantly higher not only in comparison to the control group (1.6 times, P < 0.05), but also in comparison to patients with ANCA-associated vasculitis (1.9 times, P < 0.01). According to the ROC analysis of the elastin diagnostic value for differential diagnosis of polyarteritis nodosa and ANCA-associated vasculitis, the AUC was 0.81 ± 0.10; 95 % CI 0.60–1.00; sensitivity 75 %, specificity 89 %, P < 0.01.
Conclusions. The elevated level of alpha-actin-2 with high sensitivity and specificity allows the diagnosis of ANCA-associated vasculitis in patients suspected of these diseases. The serum level of elastin is almost twice as high in patients with polyarteritis nodosa compared to patients with ANCA-associated vasculitis, which can be used in the differential diagnosis of primary systemic vasculitis. An elevated serum endothelin-1 level is found in patients with kidney damage.
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