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

doi:10.3969/j.issn.1671-7171.2017.10.012

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Abstract 【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 statistically evaluated;At the same time, the patients were scored by ACR 1987 classification criteria.The sensitivity, 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 patients 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 examination 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 diagnostic 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 multiple 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 examination standard.The affected joint evidence provided by 2010 PDUS (+) has higher diagnostic efficacy.

Key words： Synovitis/US Arthritis, Rheumatoid/US Reference Standards Early Diagnosis

Received: 19 June 2017

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R686.7

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http://www.jcr.net.cn/EN/10.3969/j.issn.1671-7171.2017.10.012 OR http://www.jcr.net.cn/EN/Y2017/V34/I10/1911

[1]葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:808-809.
[2]Szkudlarek M,Court-Payen M,Jacobsen S,et al.Interobserver agreement in ultr-asonography of the finger and toe joints in rheumatoid arthritis[J].Arthritis Rheum,2003,48(4):955-962.
[3]Wakefield RJ,Balint PV,Szkudlarek M,et al.Musculoskeletal ultrasound including definitions for ultrasonographic pathology[J].J Rheumatol,2005,32(12):2481-2487.
[4]Aletaha D,Neogi T,Silman AJ,et al.2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J].Arthritis Rheum,2010,62(9):2569-2581.
[5]Neogi T,Aletaha D,Silman AJ,et al.The 2010 American College of Rheumatolog-y/European League Against Rheumatism classification criteria for rheumatoid arthritis:Phase 2 methodological report.American College of Rheumatology; European League Against Rheumatism[J].Arthritis Rheum,2010,62(9):2582-2591.
[6]Felson DT,Smolen JS,Wells G,et al.American College of Rheumatology/ European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials[J].Ann Rheum Dis,2011,70(3):404-413.
[7]Fautrel B,Combe B,Rincheval N,et al.Level of agreement of the ACR 1987 and 2010 ACR/EULAR rheumatoid arthritis classification criteria:an analysis based on ESPOIR cohort data[J].Ann Rheum Dis,2012,71(3):386-389.
[8]Britsemmer K,Ursum J,Gerritsen M,et al.Validation of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis:slight improvement over the ACR 1987 criteria[J].Ann Rheum Dis,2011,70(8):1468-1470.
[9]Van der Linden MP,Knevel R,Huizinga TW,et al.Classification of rheumatoid arthritis:comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against Rheumatism criteria[J].Arthritis Rheum,2011,63(1):37-42.
[10]Finckh A,Liang MH,van Herckenrode CM,et al.Long-term impact of early treatment on radiographic progression in rheumatoid arthritis:a meta-analysis[J].Arthritis Rheum,2006,55(6):864-872.
[11]吕芳,李兴福.2010年美国风湿病学会联合欧洲抗风湿病联盟的类风湿关节炎分类标准解读[J].诊断学理论与实践,2010,9(4):307-310.
[12]Felson DT,Smolen JS,Wells G,et al.American College of Rheumatology/ European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials[J].Ann Rheum Dis,2011,70(3):404-413.
[13]Salaffi F,Filippucci E,Carotti M,et al.Inter-observer agreement of standard joint counts in early rheumatoid arthritis:a comparison with grey scale ultrasonography--a preliminary study[J].Rheumatology (Oxford),2008,47(1):54-58.
[14]Marhadour T,Jousse-Joulin S,Chales G,et al.Reproducibility of joint swelling assessments in long-lasting rheumatoid arthritis:influence on Disease Activity Score-28 values (SEA-Repro study part I)[J].J Rheumatol,2010,37(5):932-937.
[15]Alexandra N Colebatch,Christopher John Edwards,et al.EULAR recommend- ations for the use of imaging of the joints in the clinical management of rheumatoid arthritis[J].Ann Rheum Dis,2013,72(6):804-814.
[16]张晓慧.张卓莉.欧洲抗风湿病联盟关于影像学技术在类风湿关节炎患者管理中应用的十条建议[J].中华风湿病学杂志,2013(6);427.
[17]Matthias Witt,Felix Mueller,et al.Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis[J].Arthritis Rheum,2013,65(7):1694-1701.
[18]Ohrndorf S,Backhaus M.Ultrasound examination in rheumatoid arthritis [J].Dtsch Med Wochenschr,2015,140(16):1223-1226.
[19]Iagnocco A,Ceccarelli F,Mennini M,et al.Subclinical synovitis detected by ultrasound in children affected by coeliac disease:a frequent manifestation improved by a gluten-free diet[J].Clin Exp Rheumatol,2014,32(1):1137-1142.
[20]魏小雨,朱家安,陈征,等.微血流成像技术在类风湿关节炎中的应用价值[J].中国超声医学杂志,2015,31(9).818-820.
[21]贾建平,陈生弟.第7版神经病学[M].北京:人民卫生出版社,2013:61-69.
[22]Daiki Nakagomi,Kei Ikeda,Ayako Okubo,et al.Ultrasound can improve the accuracy of the 2010 American college of rheumatology/European league against rheumatism classification criteria for rheumatoid arthritis to predict the requirement for methotrexate treatment[J].Arthritis Rheum,2013,65(4):890-898.