不同診斷標準在血清陰性脊柱關節病患者之間的診斷效能比較_《華西醫學》

作者：

劉磊 , 劉怡欣 , 謝其冰 ,  劉鋼

四川大學華西醫院風濕免疫科（成都，610041）;

關鍵詞：

性血清陰性脊柱關節病診斷分類標準

DOI：

10.7507/1002-0179.20130177

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目的　探討不同診斷或分類標準在脊柱關節病患者之間診斷效能、臨床特點。方法　收集2000年2月－2012年8月141例脊柱關節病患者及197例類風濕關節炎、未分化關節炎患者資料。采用3種診斷標準下對141例患者分為紐約標準（NY）組、歐洲脊柱關節病研究（ESSG）組及脊柱關節病國際評估（ASAS）組，統計患者的臨床表現、骶髂關節CT、MRI、實驗室指標，并加入197例類風濕關節炎未分化關節炎患者，計算和比較3種診斷的敏感性、特異性。結果　在141例脊柱關節病中，62例符合NY標準，34例符合ESSG標準，45例只符合ASAS標準。3組患者在性別、胸廓受限、附著點炎及跖（指）炎、非甾體抗炎藥及慢作用藥使用、炎癥因子水平方面差異無統計學意義（P＞0.05）；ASAS組則較19 NY組及ESSG組患者更年輕、病程較短，且表現有外周關節炎明顯高于其余兩組（P＜0.05）；NY組炎性腰背痛、脊柱活動受限、HLA-B27陽性率明顯高于其余兩組，且使用生物制劑比例最高，達48.38；在骨盆X線、骶髂關節CT表現關節侵蝕上，NY組較其他兩組更嚴重。NY、ESSG、ASAS分類標準敏感性依次為43.97%、47.51%、73.76%，特異性依次為100.00%、90.86%、84.26%。結論　ASAS分類標準敏感性高，患者更年輕、病程更短，炎性腰背痛、外周關節炎是ASAS診斷中非常重要的指標；NY組脊柱活動受限及關節侵蝕最顯著，HLA-B27陽性可能是預測AS很好的指標。NY標準特異性最高，敏感性最低，而ASAS標準敏感性最高，特異性最低。

引用本文： 劉磊,劉怡欣,謝其冰,劉鋼. 不同診斷標準在血清陰性脊柱關節病患者之間的診斷效能比較. 華西醫學, 2013, 28(4): 554-559. doi: 10.7507/1002-0179.20130177 復制

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12.	van den Berg R, van der Heijde DM. How should we diagnose spondyloarthritis according to the ASAS classification criteria[J]. Pol Arch Med Wewn, 2010, 120(11): 452-457.
13.	Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of Spondylo Arthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general [J] . Ann Rheum Dis, 2011, 70(1): 25-31.
14.	Kiltz U, Baraliakos X, Karakostas P, et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study[J]. Ann Rheum Dis, 2012, 71(7): 1207-1211.
15.	van den Berg R, van Gaalen F, van der Helm-van Mil A, et al. Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden early arthritis cohort[J]. Ann Rheum Dis, 2012, 71(8): 1366-1369.
16.	Underwood MR, Dawes P. Inflammatory back pain in primary care [J]. Br J Rheumatol, 1995, 34(11): 1074-1077.
17.	Rudwaleit M. New approaches to diagnosis and classification of axial and peripheral spondyloarthritis[J]. Curr Opin Rheumatol, 2010, 22(4) : 375-380.
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19.	Liu X, Li YR, Hu LH, et al. High frequencies of HLA-B27 in Chinese patients with suspected of ankylosing spondylitis[J]. Rheumatol Int, 2010, 30(10): 1305-1309.
20.	Rudwaleit M, Jurik AG, Hermann KG, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group[J]. Ann Rheum Dis , 2009, 68(10): 1520-1527.
21.	倪立青. 強直性脊柱炎的鑒別診斷[J]. 中國新藥與臨床雜志，1999, 18(11): 383-384.
22.	陶錫東. 強直性脊柱炎與腰椎間盤突出癥鑒別體會[J]. 頸腰痛雜志, 2002, 23(2): 148-149.
23.	馬樹國, 武志峰. 強直性脊柱炎與致密性骨炎的CT鑒別診斷[J]. 實用醫學影像雜志, 2002, 3(4): 280-281.
24.	Mathur T, Manadan AM, Hota B, et al. Pseudo-septic hip arthritis as the presenting symptom of ankylosing spondylitis: a case series and review of the literature [J] . Clin Exp Rheumatol, 2010, 28(3): 416-418.
25.	Bao J. Young males with primary lymphoma of bone presenting with musculoskeletal pain are prone to be misdiagnosed as ankylosing spondylitis: a case report[J]. Rheumatol Int, 2012, 32(1): 263-264.
26.	Davis JC Jr, Van der Heijde DM, Dougados M, et al. Baseline factors that influence ASAS 20 response in patients with ankylosing spondylitis treated with etanercept[J]. J Rheumatol, 2005, 32(9): 1751-1754.

1. 　Sieper J, Rudwaleit M, Khan MA, et al. Concepts and epidemiology of spondy-loarthritis[J]. Best Pract Res Clin Rheumatol, 2006, 20(6): 401-417.
2. 　Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors[J]. Arthritis Rheum, 1998, 41(1): 58-67.
3. 　Feldtkeller E, Khan MA, van der Heijde D, et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis[J]. Rheumatol Int, 2003, 23(3): 61-66.
4. 　Rudwaleit M, van der Heijde D, Khan MA, et al. How to diagnose axial spondyloarthritis early[J]. Ann Rheum Dis, 2004, 63(5): 535-543.
5. 　Dougados M, van der Linden S, Juhlin R, et al .The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy[J]. Arthritis Rheum, 1991, 34(10): 1218-1227.
6. 　Sieper J, Rudwaleit M, Baraliakos X, et al . The Assessment of Spondylo arthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis [J] . Ann Rheum Dis, 2009, 68(6): 1-44.
7. 　陸再英, 鐘南山, 謝毅, 等. 內科學[M]. 7版, 北京：人民衛生出版社, 2008: 852-853.
8. 　Chung HY, Lau CS, Wu KP, et al. Comparison of performance of the Assessment of Spondyloarthritis International Society, the European Spondyloarthropathy Study Group and the modified New York criteria in a cohort of Chinese patients with spondyloarthritis[J]. Clin Rheumatol, 2011, 30(7): 947-953.
9. 　Brandt J, Khariouzov A, Listing J, et al . Six-month results of a double-blind, placebo controlledtrial of etanercept treatment in patients with active ankylosing Spondylitis[J]. Arthritis Rheum, 2003, 48(6): 1667-1675.
10. 　van Tubergen A, Weber U. Diagnosis and classification in spondyloarthritis: identifying a chameleon[J]. Nat Rev Rheumatol, 2012, 8(3): 253-261.
11. 　Feldtkeller E, Erlendsson J. Definition of disease duration in ankylosing spondylitis [J]. Rheumatol Int, 2008 , 28(4): 693–696.
12. 　van den Berg R, van der Heijde DM. How should we diagnose spondyloarthritis according to the ASAS classification criteria[J]. Pol Arch Med Wewn, 2010, 120(11): 452-457.
13. 　Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of Spondylo Arthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general [J] . Ann Rheum Dis, 2011, 70(1): 25-31.
14. 　Kiltz U, Baraliakos X, Karakostas P, et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study[J]. Ann Rheum Dis, 2012, 71(7): 1207-1211.
15. 　van den Berg R, van Gaalen F, van der Helm-van Mil A, et al. Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden early arthritis cohort[J]. Ann Rheum Dis, 2012, 71(8): 1366-1369.
16. 　Underwood MR, Dawes P. Inflammatory back pain in primary care [J]. Br J Rheumatol, 1995, 34(11): 1074-1077.
17. 　Rudwaleit M. New approaches to diagnosis and classification of axial and peripheral spondyloarthritis[J]. Curr Opin Rheumatol, 2010, 22(4) : 375-380.
18. 　Rudwaleit M, Metter A, Listing J, et al. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history or application as classification and diagnostic criteria[J]. Arthritis Rheum, 2006, 54(2): 569-578.
19. 　Liu X, Li YR, Hu LH, et al. High frequencies of HLA-B27 in Chinese patients with suspected of ankylosing spondylitis[J]. Rheumatol Int, 2010, 30(10): 1305-1309.
20. 　Rudwaleit M, Jurik AG, Hermann KG, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group[J]. Ann Rheum Dis , 2009, 68(10): 1520-1527.
21. 　倪立青. 強直性脊柱炎的鑒別診斷[J]. 中國新藥與臨床雜志，1999, 18(11): 383-384.
22. 　陶錫東. 強直性脊柱炎與腰椎間盤突出癥鑒別體會[J]. 頸腰痛雜志, 2002, 23(2): 148-149.
23. 　馬樹國, 武志峰. 強直性脊柱炎與致密性骨炎的CT鑒別診斷[J]. 實用醫學影像雜志, 2002, 3(4): 280-281.
24. 　Mathur T, Manadan AM, Hota B, et al. Pseudo-septic hip arthritis as the presenting symptom of ankylosing spondylitis: a case series and review of the literature [J] . Clin Exp Rheumatol, 2010, 28(3): 416-418.
25. 　Bao J. Young males with primary lymphoma of bone presenting with musculoskeletal pain are prone to be misdiagnosed as ankylosing spondylitis: a case report[J]. Rheumatol Int, 2012, 32(1): 263-264.
26. 　Davis JC Jr, Van der Heijde DM, Dougados M, et al. Baseline factors that influence ASAS 20 response in patients with ankylosing spondylitis treated with etanercept[J]. J Rheumatol, 2005, 32(9): 1751-1754.

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不同診斷標準在血清陰性脊柱關節病患者之間的診斷效能比較

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不同診斷標準在血清陰性脊柱關節病患者之間的診斷效能比較

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