Freemont A J, Denton J, Chuck A, Holt P J, Davies M
Department of Rheumatology, University of Manchester Medical School.
Ann Rheum Dis. 1991 Feb;50(2):101-7. doi: 10.1136/ard.50.2.101.
This study is in two parts. In the first synovial fluid from 1892 patients with 14 different arthropathies was examined microscopically. Crystals of different types were identified and the disease distribution of these and various cell types, including several not previously reported in synovial fluid, have been described. These features have been used to derive a series of microscopic diagnostic criteria for each arthropathy. The criteria have been used in the second part of the study to examine synovial fluids from 200 patients without knowledge of any clinical diagnosis. Cytological and clinical diagnoses were compared at the end of the study. Matching diagnoses were made in 71 (35.5%) and a short list of differential diagnoses (based on cytological criteria), which included the clinical diagnosis, was made in a further 43 (21.5%). Of the rest, 63 (31.5%) were correctly described as inflammatory or non-inflammatory and in five (2.5%) no diagnosis could be made. Only in seven cases (3.5%) was an inaccurate (false positive) cytological diagnosis made. The results indicate that synovial fluid microscopy is a potentially more important diagnostic screening test in rheumatological and orthopaedic practice than it would at first appear from published reports.
本研究分为两个部分。第一部分，对1892例患有14种不同关节病的患者的滑液进行了显微镜检查。识别出了不同类型的晶体，并描述了这些晶体以及各种细胞类型（包括几种以前未在滑液中报道过的细胞类型）的疾病分布情况。利用这些特征为每种关节病得出了一系列显微镜诊断标准。在研究的第二部分中，运用这些标准对200例患者的滑液进行检查，检查时对任何临床诊断情况均不知情。在研究结束时，将细胞学诊断与临床诊断进行了比较。71例（35.5%）诊断匹配，另有43例（21.5%）得出了一份包括临床诊断在内的简短鉴别诊断清单（基于细胞学标准）。其余病例中，63例（31.5%）被正确描述为炎症性或非炎症性，5例（2.5%）无法做出诊断。只有7例（3.5%）做出了不准确（假阳性）的细胞学诊断。结果表明，在风湿病学和骨科实践中，滑液显微镜检查作为一种诊断筛查试验，其潜在重要性可能比从已发表的报告中乍看时更为突出。
