滑膜炎超声影像在评估早期类风湿性关节炎中的诊断价值

[目的]探讨超声检查滑膜炎影像证据应用于2010ACR/EULAR类风湿关节炎(RA)分类标准对评估RA早期诊断的价值.[方法]严格选取54例疑似RA的早期患者,所有患者进行38关节超声检查[GSUS≥1及PDUS(+)]和临床体格检查,分别统计受累关节的数目和部位,将上述三种方法统计的受累关节结果应用于2010ACR/EULAR分类标准评分,统计评分结果.同时对患者进行ACR1987分类标准进行评分.依据《2010ACR/EULAR分类标准联合倡议》以患者使用DMARDs治疗或(和)风湿专科医生判断为RA作为诊断RA的"金标准",计算不同分类标准的敏感性和特异性等指标.比较不同分类标准(方法)间的差异.[结果]54例中以上述标准最终诊断RA37例,符合2010ACR/EULARGSUS≥1标准39例,符合2010ACR/EULARPDUS(+)标准21例,符合2010ACR/EULAR临床体检标准27例,符合ACR1987标准18例.超声不同评估标准GSUS≥1,PDUS(+)与临床体检对"受累关节"检出率比较,GSUS≥1全部关节检出率,PDUS(+)跖趾关节检出率,GSUS≥1总检出率高于临床体检,差异具有统计学意义(P<0.05).2010ACR/EULAR超声不同标准敏感性均高于2010ACR/EULAR临床体检标准及ACR1987标准;其中以2010GSUS≥1敏感性最高,ACR1987最低;特异性PDUS(+)最高,2010GSUS≥1最低;诊断符合率2010GSUS≥1最高,ACR1987最低;约登指数最高为PDUS(+),Kappa值最高为2010GSUS≥1;诊断可靠性(AUC)以2010PDUS(+)最高.[结论]超声不同评估标准能够在多个关节检出临床体检无法发现的亚临床滑膜炎,其中GSUS≥1全部关节、PDUS(+)跖趾关节检出率较高.超声不同评估标准提供关节受累证据应用于2010ACR/EULAR分类标准后该标准诊断效能均高于ACR1987标准及2010ACR/EULAR临床体检标准,诊断效能以2010PDUS(+)提供关节受累证据较高.

Evaluation of Synovial Evidence in the Diagnosis of Early Rheumatoid Arthritis by Ultrasound

[Objective] To investigate the value of ultrasonography in the early diagnosis of RA in 2010 ACR/EULAR classification criteria.[Methods] Fifty-four cases of early patients with suspected RA were strictly selected,and all patients were tested by ultrasound of 38 jionts[GSUS≥1 and PDUS(+)]and clinical physical examination;the number and location of affected joints were counted,and the results of the three methods were applied to the 2010 ACR/EULAR classification standard score,and the score results were sta-tistically evaluated;At the same time,the patients were scored by ACR 1987 classification criteria.The sensi-tivity,specificity and the different classification criteria were calculated according to the use of DMARDs and (or)the RA judged rheumatoid specialist as a "gold standard"for the diagnosis of RA on the base of "2010 ACR/EULAR Classification Standard Joint Initiative".The difference between different classification criteria (Methods)was compared.[Results]Of the 54 cases,37 were diagnosed as RA with the above criteria,39 pa-tients met 2010 ACR/EULAR GSUS(+)standard,21 cases met the standard of 2010 ACR/EULAR PDUS (+),27 cases met the 2010 ACR/EULAR clinical physical examination standard,and18 cases met the ACR 1987 standard.Of the different ultrasonic evaluation standard GSUS ≥1,the comparison of PDUS(+)and clinical physical examination on the detection rate of affected joints,the detection rate of GSUS ≥ 1 of all joints,the detection rate of PDUS(+)metatarsophalangeal jointthe and the GSUS ≥1 total detection rate were all higher than those of the clinical examination,the difference was statistically significant(P <0.05).The standard sensitivity of 2010 ACR/EULAR ultrasound was higher than 2010 ACR/EULAR clinical physical ex-amination standard and ACR 1987 standard:the sensitivity of 2010 GSUS≥1 was the highest,and ACR 1987 was the lowest;the specificity of PDUS(+)was the highest,and the lowest was 2010 GSUS≥1;the diag-nostic coincidence rate was 2010 GSUS≥1,and ACR 1987 was the lowest;the highest Youden's index was PDUS(+),the highest Kappa value was 2010 GSUS≥1;2010 PDUS(+)was the highest in the diagnostic reliability(AUC).[Conclusion]Different ultrasonic evaluation criteria can detect subclinical synovitis in multi-ple joints where as that the usual clinical examination is unable to find out,among which the GSUS≥1 and PDUS(+)metatarsophalangeal joint hold the higher detection rate.Evidence of affected joint involvement provided by the different ultrasound evaluation standards is applied to the 2010 ACR/EULAR classification standard,whose efficiency is higher than that of ACR 1987 standard and ACR/EULAR 2010clinical examina-tion standard.The affected joint evidence provided by 2010 PDUS(+)has higher diagnostic efficacy.