de Miguel E, Cobo T, Muñoz-Fernández S, Naredo E, Usón J, Acebes J C, Andréu J L, Martín-Mola E
Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain.
Ann Rheum Dis. 2009 Feb;68(2):169-74. doi: 10.1136/ard.2007.084251. Epub 2008 Apr 7.
To develop an ultrasound enthesis score and to assess its validity in the diagnostic classification of the spondyloarthropathies (SpAs).
Twenty-five patients with SpA and 29 healthy controls participated in a blinded, gender-matched, cross-sectional study involving ultrasound assessment. The following entheses were explored bilaterally: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar ligament, distal quadriceps and brachial triceps tendons. The ultrasound score evaluated enthesis thickness, structure, calcifications, erosions, bursae and power Doppler signal. The value of each elemental lesion was calculated using a three-model analysis. Validity was analysed by receiver operating characteristic (ROC) curves. Inter-reader and interexplorer intraclass correlation coefficients (ICCs) were calculated.
The logistic regression model overestimated the score of three elemental lesions: calcification (0-3), Doppler (0 or 3) and erosion (0 or 3), while scoring tendon structure, tendon thickness and bursa as 0 or 1. ROC curves established an ultrasound score of >or=18 as the best cut-off point for differentiation between cases and controls. This cut-off point was exceeded by 5/29 controls (17%) and by 21/25 patients with SpA (84%). The sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) were 83.3%, 82.8%, 4.8% and 0.2%, respectively. The inter-reader and interexplorer ICCs were 0.60 and 0.86, respectively.
The findings suggest that the ultrasound enthesis score could be a valid tool in the diagnosis of SpA.
制定一项超声附着点评分，并评估其在脊柱关节病（SpA）诊断分类中的有效性。
25例SpA患者和29名健康对照者参与了一项涉及超声评估的双盲、性别匹配横断面研究。双侧检查以下附着点：足底近端筋膜、跟腱远端、髌韧带远近端、股四头肌远端和肱三头肌腱。超声评分评估附着点厚度、结构、钙化、侵蚀、滑囊和能量多普勒信号。每个基本病变的值通过三模型分析计算。通过受试者工作特征（ROC）曲线分析有效性。计算阅片者间和检查者间组内相关系数（ICC）。
逻辑回归模型高估了三个基本病变的评分：钙化（0 - 3）、多普勒（0或3）和侵蚀（0或3），而将肌腱结构、肌腱厚度和滑囊评分为0或1。ROC曲线确定超声评分≥18为区分病例和对照的最佳切点。29名对照者中有5名（17%）超过了该切点，25例SpA患者中有21名（84%）超过了该切点。敏感性、特异性、阳性和阴性似然比（LR +，LR -）分别为83.3%、82.8%、4.8%和0.2%。阅片者间和检查者间的ICC分别为0.60和0.86。
研究结果表明，超声附着点评分可能是SpA诊断的有效工具。
