CAJ | 학술논문

目的多中心验证并比较早期RA (ERA)分类标准与1987年ACR和2010年ACR/EULAR分类标准在病程≤1年的ERA诊断中的敏感性和特异性.方法按照国际通用的标准验证方法,入选病程≤1年,年龄＞18岁,至少有1个以上部位关节炎的患者,详细记录发病情况,包括关节肿胀部位、持续时间、对称性、晨僵时间、皮下结节以及伴随症状等,检测其血清中抗CCP抗体、RF、ESR以及CRP等指标,并记录关节影像学改变的特点,经2名风湿科专科医师进行临床诊断,未确诊的患者每3个,月随访1次,共随访1年.比较ERA标准和1987年ACR以及2010年ACR/EULAR标准在ERA分类诊断中的敏感性和特异性.组间比较采用X2检验,敏感性和特异性比较采用Mc Nemar检验,阳性预测值比较采用Score检验.结果 ①共入组患者271例,1年随访结束时确诊病例256例,其中RA 120例,非RA136例;未确诊病例15例.②ERA标准的敏感性(76.7％)略高于2010年标准(70.0％),差异无统计学意义(P=0.115);但2010年标准(70.0％)和ERA标准(76.7％)的敏感性均明显高于1987年标准(51.7％),差异有统计学意义(x2=11.524,P＜0.01;x2=26.471,P＜0.01).ERA标准、2010年标准和1987年标准的特异性相似,分别为83.8％、83.8％和86.8％.结论 ERA分类标准在ERA诊断中的敏感性稍高于2010年ACR/EULAR分类标准,明显高于1987年ACR分类标准;3个标准在ERA诊断中的特异性相当,但ERA标准更为简单实用,可用于ERA的临床诊断.
목적 다중심험증병비교조기RA (ERA)분류표준여1987년ACR화2010년ACR/EULAR분류표준재병정≤1년적ERA진단중적민감성화특이성.방법 안조국제통용적표준험증방법,입선병정≤1년,년령＞18세,지소유1개이상부위관절염적환자,상세기록발병정황,포괄관절종창부위、지속시간、대칭성、신강시간、피하결절이급반수증상등,검측기혈청중항CCP항체、RF、ESR이급CRP등지표,병기록관절영상학개변적특점,경2명풍습과전과의사진행림상진단,미학진적환자매3개,월수방1차,공수방1년.비교ERA표준화1987년ACR이급2010년ACR/EULAR표준재ERA분류진단중적민감성화특이성.조간비교채용X2검험,민감성화특이성비교채용Mc Nemar검험,양성예측치비교채용Score검험.결과 ①공입조환자271례,1년수방결속시학진병례256례,기중RA 120례,비RA136례;미학진병례15례.②ERA표준적민감성(76.7％)략고우2010년표준(70.0％),차이무통계학의의(P=0.115);단2010년표준(70.0％)화ERA표준(76.7％)적민감성균명현고우1987년표준(51.7％),차이유통계학의의(x2=11.524,P＜0.01;x2=26.471,P＜0.01).ERA표준、2010년표준화1987년표준적특이성상사,분별위83.8％、83.8％화86.8％.결론 ERA분류표준재ERA진단중적민감성초고우2010년ACR/EULAR분류표준,명현고우1987년ACR분류표준;3개표준재ERA진단중적특이성상당,단ERA표준경위간단실용,가용우ERA적림상진단.
Objective To evaluate the classification criteria for early rheumatoid arthritis (ERA) in a multi-center cohort,and compare the specificity and sensitivity among ERA criteria,1987 ACR criteria and 2010 ACR/EULAR criteria.Methods Patients who had arthritic complaints with disease duration no more than 1 year,and age more than 18 years were enrolled.The clinical and laboratory parameters were recorded.The patients were diagnosed by 2 experienced rheumatologists based on the clinical and laboratory features.Undiagnosed patients were followed up every 3 months till 1 year.Chi-square test was performed to compare among groups.Mc Nemar test was performed to compare the sensitivity and specifity.Score test were used to test the positive and negative predictive values.Results A total of 271 patients were enrolled in this study.By the end of one year follow-up,120 patients were diagnosed as RA,136 patients were diagnosed to be other diseases,and 15 patients remained unclassified.The sensitivity of ERA criteria (76.7％) was much higher than 1987 ACR criteria (51.7％),there was significant difference (x2=1 1.524,P＜0.01; x2=26.471,P＜0.01),and similar to 2010 ACR/EULAR criteria (70.0％); while the specificity among the three criteria was similar.Conclusion The diagnostic value of the ERA criteria is better than 1987 ACR criteria,and it is more simple than 2010 ACR/EULAR criteria.The ERA criteria may be applicable to clinical practice for early RA diagnosis.