早期类风湿关节炎分类标准及其诊断意义的探讨  

Establishment and evaluation of classification criteria for early rheumatoid arthritis

作　　者：赵金霞[1,2] 苏茵[1] 刘湘源[2] 叶华[1] 李茹 邹庆华[3] 方勇飞[3] 刘花香[4] 李兴福[4] 郭嘉隆[5] 毕黎琦[5] 顾菲[6] 孙凌云[6] 梅轶芳[7] 张志毅[7] 陈丽娜[8] 朱平[8] 李光韬[9] 张卓莉[9] 冷晓梅[10] 赵岩[10] 姜莉[11] 邹和建[11] 赵毅[12] 刘毅[12] 李蕾[13] 王洪源[13] 栗占国[1] 

机构地区：[1]北京大学人民医院风湿免疫科,100044 [2]北京大学第三医院风湿免疫科 [3]第三军医大学西南医院风湿免疫科 [4]山东大学齐鲁医院风湿免疫科 [5]吉林大学中日联谊医院风湿免疫科 [6]南京大学医学院附属鼓楼医院风湿免疫科 [7]哈尔滨医科大学第一附属医院风湿免疫科 [8]第四军医大学西京医院风湿免疫科 [9]北京大学第一医院风湿免疫科 [10]中国医学科学院北京协和医院风湿免疫科 [11]复旦大学附属华山医院风湿科 [12]四川大学华西医院风湿免疫科 [13]北京大学公共卫生学院流行病与卫生统计学系

出　　处：《中华风湿病学杂志》2012年第10期651-656,共6页Chinese Journal of Rheumatology

基　　金：“十一五”国家科技支撑计划（2008BA159801）

摘　　要：目的通过分析早期炎性关节炎患者的临床、实验室以及影像学特征，提出早期类风湿关节炎（ERA）分类标准，并评价其在早期RA分类诊断中的价值。方法入选病程〈1年、年龄〉16岁的明确关节炎的患者。详细记录其发病情况，包括关节肿痛部位、持续时间、对称性、晨僵时间、皮下结节等，检测其血清中抗环瓜氨酸肽（CCP）抗体、类风湿因子（RF）、红细胞沉降率（ESR）以及C反应蛋白（CRP）等指标，并记录关节影像学改变的特点。经风湿病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。分析入选时各项指标，将敏感性和特异性较高的指标纳入新的早期RA分类标准，并建立计分法的早期RA分类标准。采用t检验彭检验和Logistic回归分析进行统计分析。结果①共纳入病程〈1年的早期关节炎患者803例，经1年随访，514例确诊为早期RA，251例确诊为其他风湿性疾病，38例仍未能确诊。②将对早期RA分类诊断敏感性或特异性较高的指标纳入新的早期RA分类标准（称为早期RA分类标准），其在早期RA分类诊断中的敏感性为84．4％，明显优于1987年美国风湿病学会（ACR）分类标准的58．0％，而特异性差异无统计学意义，分别为87．4％与93．6％。③与2010年ACR／欧洲抗风湿联盟（EULAR）分类标准复杂的评分系统相比，早期RA分类标准更简便实用，且其敏感性和特异性均较高于文献报道的2010年ACR／EULAR分类标准。④通过Logistic回归分析建立计分法的早期RA分类标准，该标准在早期RA诊断中的敏感性为86．4％，明显优于1987年ACR分类标准的58．0％。结论早期RA分类标准在早期RA诊断中的临床价值明显优于1987年ACR分类标准，与2010年ACRfEULAR的RA分类标准相比，更简便实用，有利于早期RA的临床诊断。Objective To establish new classification criteria for early rheumatoid arthritis （E-RA）based on large samples of early inflammatory arthritis patients and to evaluate the value of this criteria in China. Methods Patients who had arthritic complaints with disease duration less than one year were enrolled. They were divided in~＇ RA group and non-RA group according to the clinical diagnosis by experienced rheum- atologists. The clinic,al and laboratory parameters were analyzed and those with high sensitivity or specificity were selected as the new classification criteria. Statistical analysis was carried out by using t test, X^2 test and Logistic regression. Results ① A total of 803 patients with early inflammatory arthritis were included in this study. Five hundreds and fourteen patients were diagnosed as early RA and 251 were diagnosed as other rheumatic diseases, and the diagnosis of 38 patients remained unestablished by the end of follow-up. ② New E-RA classification criteria were established based on the parameters with high sensitivity and/or specificity. The sensitivity of the new E-RA criteria was 84.4%, which was higher than 1987 ACR criteria （58.0%）, while the corresponding specificities were similar, which were 87.4% and 93.6% respectively. ③Compared with the complex scoring system of 2010 ACR/EULAR criteria, the E-RA criteria was more simple and practical. The diagnostic sensitivity and specificity of E-RA criteria were higher than those of 2010 ACR/EULAR criteria reported in the literatures. ④ New classification criteria based on scoring system using Logistic regression analysis was established. The sensitivity of this criteria was 86.4%, which was higher than 1987 ACR criteria （58.0%）. Conclusion The diagnostic value of the E-RA criteria developed in this study for early RA is better than 1987 ACR criteria, and is more simple than 2010 ACR/EULAR criteria. It may be used as a new classification criteria for early RA diagnosis.

关 键 词：关节炎 类风湿 早期诊断 分类标准 

分 类 号：R593.22[医药卫生—内科学]