Abdullah S, Young-Min S A, Hudson S J, Kelly C A, Heycock C R, Hamilton J D
Department of Rheumatology, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK.
J Clin Pathol. 2007 Oct;60(10):1144-7. doi: 10.1136/jcp.2006.043950. Epub 2007 Jan 26.
To develop an objective and easy to complete standardised questionnaire for documentation of synovial fluid (SF) gross appearance and use it in the assessment of patients presenting to the rheumatology service with a joint effusion.
A standardised questionnaire to record the gross appearance of SF was developed. Interobserver error in recorded observations and direct gross analysis of synovial fluid between four observers was calculated in a pilot study. In a prospective study over 8 months, SF gross analysis and cell count were documented in all patients presenting with a joint effusion. Fusch Rosenthal manual counting chamber was used for calculating SF cell counts.
There was good interobserver agreement on direct gross analysis and between questionnaire assessors (mean kappa 0.889). 80 SF samples were collected. Gross analysis was performed in all samples and cell count in 72. Of the specimens thought to be inflammatory on gross analysis, 31% were found to be non-inflammatory based on cell count; however, 12 of these patients had an established inflammatory arthritis. Gross analysis had a sensitivity of 94% and specificity of 58% when used to determine whether SF is inflammatory or non-inflammatory. The positive and negative predictive values were 0.69 and 0.91 respectively.
SF cell count did not add any information when SF gross analysis suggested a non-inflammatory process. Gross analysis was better than cell count to determine a potentially septic joint fluid. Further work needs to be done on the value of SF cell counts if gross analysis suggests the fluid to be inflammatory.
制定一份客观且易于填写的标准化问卷，用于记录滑液（SF）的大体外观，并将其用于评估风湿科就诊的关节积液患者。
制定一份记录SF大体外观的标准化问卷。在一项初步研究中，计算了四位观察者记录观察结果时的观察者间误差以及对滑液的直接大体分析结果。在一项为期8个月的前瞻性研究中，记录了所有关节积液患者的SF大体分析和细胞计数。使用福斯-罗森塔尔手动计数室计算SF细胞计数。
在直接大体分析方面以及问卷评估者之间，观察者间一致性良好（平均kappa值为0.889）。共收集了80份SF样本。对所有样本进行了大体分析，72份样本进行了细胞计数。在大体分析认为是炎性的标本中，基于细胞计数发现31%为非炎性；然而，这些患者中有12例患有确诊的炎性关节炎。当用于确定SF是炎性还是非炎性时，大体分析的敏感性为94%，特异性为58%。阳性预测值和阴性预测值分别为0.69和0.91。
当SF大体分析提示为非炎性过程时，SF细胞计数并未增加任何信息。在确定潜在的感染性关节液方面，大体分析优于细胞计数。如果大体分析提示液体为炎性，需要进一步研究SF细胞计数的价值。
