摘要
目的评价类风湿关节炎(RA)2010ACR/EULAR分类标准(简称2010标准)与1987ACR诊断标准(简称1987标准)的诊断效能。方法回顾性分析2009年5月至2011年6月期间南方医科大学南方医院门诊和住院的114例早期关节炎患者。分别以患者一年内使用甲氨蝶呤/来氟米特治疗、一年时风湿专科医生判断为RA作为诊断RA的"金标准",评价两种分类标准的诊断效能。结果 2010标准与1987标准敏感性分别为0.87和0.63(甲氨蝶呤/来氟米特使用标准)、0.91和0.76(风湿专科医生判断标准);特异性分别为0.67和0.81(甲氨蝶呤/来氟米特使用标准)、0.56和0.92(风湿专科医生判断标准);两种标准ROC曲线下面积(AUC)分别为0.89和0.86(甲氨蝶呤/来氟米特使用标准)、0.87和0.92(风湿专科医生判断标准)。按风湿专科医生判断标准,1年时39例非RA患者基线期符合2010标准的有17例(43.6%),分别为未分化关节炎(n=7)、银屑病关节炎(n=5)、干燥综合征(n=2)、系统性红斑狼疮(n=1)、自限性关节炎(n=2);1年时39例非RA患者基线期符合1987标准的有3例,均为银屑病关节炎。按风湿专科医生判断标准,基线期符合1987标准的60例RA患者有4例不符合2010标准,其血清学均正常。结论运用2010标准有利于RA的早期诊断;2010标准可能将其他关节炎和部分结缔组织病误分类为RA,对分类为RA的患者临床需加强随访;使用2010标准过程中结合1987标准可减少血清学正常的RA的漏诊风险。
Objective To evaluate the diagnostic performance of 2010ACR/EULAR classification criteria and 1987ACR criteria. Methods We assessed 114 patients with early arthritis from Nanfang Hospital from May 2009 to June 2011. The diagnostic ability of the two criteria was evaluated with methotrexate or leflunomide treatment within 1 year and expert opinion rheumatoid arthritis （RA） at 1 year as ＇gold standard＇, respectively. Results The sensitivity of the 2010ACR/EULAR classification and 1987ACR criteria were 0.87 and 0.63 （＇gold standard＇ methotrexate or leflunomide use）, 0.91 and 0.76 （＇gold standard＇ expert opinion RA）, respectively. The specificity of the two criteria were 0.67 and 0.81 （＇gold standard＇ methotrexate or leflunomide use）,0.56 and 0.92 （＇gold standard＇ expert opinion RA）, respectively. The discriminative ability of the two criteria was similar with areas under the curve （AUC） of 0.89 and 0.86 （＇gold standard＇ methotrexate or leflunomide use）,0.87 and 0.92 （＇gold standard＇ expert opinion RA）, respectively. According to expert opinion at 1 year, 17 of 39 patients without RA met the 2010ACR/EULAR classification criteria at baseline. Their diagnosis were undifferentiated arthritis（n-7）, psoriatic arthritis （n=5）, Sjogren＇s syndrome （n=2）, Systemic Lupus Erythematosus（n=1）, self-limiting arthritis（n=2）, respectively. 3 of 39 patients without RA met the 1987ACR criteria at baseline. They were all psoriatic arthritis. There were 4 patients （expert opinion RA at 1 year） with normal serological markers who did not satisfy the 2010 criteria among 60 patients but met 1987ACR criteria. Conclusion The sensitivity of the 2010ACR/EULAR criteria was higher than the 1987ACR criteria, while the specificity was lower. The discriminative ability of the two criteria was similar. The use of the 2010ACR/EULAR criteria may lead to a revoked classification as RA in patients with other arthritis or some connective tissue diseases, so the followup was necessary in clinical practice. Moreover, the use of the 2010ACR/EULAR criteria combined with 1987ACR criteria may avoid the misdiagnosis of patients with RA with normal serological markers
出处
《热带医学杂志》
CAS
2013年第5期606-610,共5页
Journal of Tropical Medicine
基金
国家自然科学基金(81173456)
广东省自然科学基金(S2012010009164)
广东省"211"工程三期重点学科建设项目
