CAJ | 학술논문

目的：通过分析2002与2012二种标准在诊断抗SSA/SSB抗体阴性的可疑原发性干燥综合征时与专家意见的一致性，比较二种分类标准的应用价值。方法：入选经3种方法检测抗SSA/SSB抗体均为阴性的可疑原发性干燥综合征患者，依照2002国际分类标准和2012美国风湿病学会标准的要求，对各患者进行系统检查和评估后，套用2002和2012二种分类标准，分别作出是否符合干燥综合征的判断。随访3个月，由3名资深风湿病专家结合随访过程中的病情演变和治疗反应等，讨论后作出专家判断意见。分析二种标准与专家意见一致性和其应用价值。结果：在26例患者中，2002标准与2012标准的诊断结果一致性欠佳；较之2002标准，2012标准与专家意见具有更好的一致性（Kappa 0.53 vs 0.32）。当假设以专家意见作为“金标准”时，2012标准的敏感性高于2002标准（85.71%vs 57.14%），且2012标准与2002标准具有相近的特异性（75.00%vs 72.73%）。结论：在鉴别抗SSA/SSB抗体阴性的疑难原发性干燥综合征患者时，根据2012标准所得诊断结论比2002标准更接近于资深专家的诊断意见，更值得风湿病医师借鉴，可加以临床推广应用。
목적：통과분석2002여2012이충표준재진단항SSA/SSB항체음성적가의원발성간조종합정시여전가의견적일치성，비교이충분류표준적응용개치。방법：입선경3충방법검측항SSA/SSB항체균위음성적가의원발성간조종합정환자，의조2002국제분류표준화2012미국풍습병학회표준적요구，대각환자진행계통검사화평고후，투용2002화2012이충분류표준，분별작출시부부합간조종합정적판단。수방3개월，유3명자심풍습병전가결합수방과정중적병정연변화치료반응등，토론후작출전가판단의견。분석이충표준여전가의견일치성화기응용개치。결과：재26례환자중，2002표준여2012표준적진단결과일치성흠가；교지2002표준，2012표준여전가의견구유경호적일치성（Kappa 0.53 vs 0.32）。당가설이전가의견작위“금표준”시，2012표준적민감성고우2002표준（85.71%vs 57.14%），차2012표준여2002표준구유상근적특이성（75.00%vs 72.73%）。결론：재감별항SSA/SSB항체음성적의난원발성간조종합정환자시，근거2012표준소득진단결론비2002표준경접근우자심전가적진단의견，경치득풍습병의사차감，가가이림상추엄응용。
Objective:By analyzing two standards of 2002 and 2012 in the diagnosis of suspected primary sj?gren syndrome with negative anti SSA/SSB antibody to compares the application value of them. Methods:Selected patients of suspected primary sj?gren syndrome with negative anti SSA/SSB antibody by the 3 methods of detection.According to the 2002 international classiifcation standards and 2012 American College of Rheumatology criteria,a systemic inspection and evaluation of them was made using 2002 and 2012 classiifcation standards to judge if they had sj?gren syndrome.After 3 months follow-up by 3 senior experts for the progression and the response to treatment,discussed their judgments and analyzed the consistency of the two classiifcation standards and experts’ opinions and the application value.Results:Of 26 patients,the consistency of the diagnosis results by 2002 and 2012 standards was poor;compared with 2002 standard,the consistency of 2012 standard and expert opinions was better (Kappa 0.53 vs 0.32).Supposed the expert opinions as "Gold standard",the sensitivity of 2012 standard was higher than that of 2002 (85.71% vs 57.14%),and the two standards had the same speciifcity (75.00% vs 72.73%).Conclusion:In the identification of anti SSA/SSB antibody negative of primary sj?gren syndrome,the diagnosis results by 2012 standard were much closer to the opinions of senior experts,worthy of clinical application.