Correspondence to Dr Eugenio de Miguel, Rheumatology Unit, Hospital Universitario La Paz, Pº de la Castellana 261, 28046 Madrid, Spain.
Ann Rheum Dis. 2011 Mar;70(3):434-9. doi: 10.1136/ard.2010.134965. Epub 2010 Dec 3.
To determine the sensitivity and specificity of enthesis ultrasound for the diagnostic classification of early spondyloarthritis.
A cross-sectional, blinded and controlled study. Standardised bilateral ultrasound of six entheses (Madrid sonography enthesitis index (MASEI)) was performed. Accepted diagnostic classification criteria were used as the gold standard. Validity was analysed by receiver operating characteristic (ROC) curves. Values of p<0.05 were considered significant.
113 early spondyloarthritis patients were included (58 women/55 men), 57 non-inflammatory control individuals (29 women/28 men) and 24 inflammatory control individuals (11 women/13 men). The evolution time of spondyloarthritis was 10.9±7.1 months. At least some grade of sacroiliitis on x-ray was present in 59 patients, but only five fulfilled the radiographic sacroiliitis New York criteria. Human leucocyte antigen B27 (HLA-B27) was positive in 42% of patients. No statistical differences were found for the enthesis score among diagnostic spondyloarthritis subtypes form of presentation (axial, peripheral or mixed) or HLA-B27 positivity. The MASEI score achieved statistical significance for gender. The ultrasound score was 23.36±11.40 (mean±SD) in spondyloarthritis patients and 12.26±6.85 and 16.04±9.94 in the non-inflammatory and inflammatory control groups (p<0.001), respectively. The ROC area under the curve was 0.82, and a cut-off point of ≥20 points achieved a likelihood ratio of 5.30 and a specificity of 89.47%.
Entheses are affected early in spondyloarthritis, and the incidence of involvement is higher in men and independent of the spondyloarthritis diagnostic subtype, HLA-B27 status or presentation pattern. The enthesis ultrasound score seems to have diagnostic accuracy and may be useful for improving the diagnostic accuracy of early spondyloarthritis.
确定附着点超声在早期强直性脊柱炎诊断分类中的敏感性和特异性。
进行了一项横断面、盲法和对照研究。对 6 个附着点（马德里超声附着点指数（MASEI））进行了标准双侧超声检查。采用公认的诊断分类标准作为金标准。通过接收者操作特征（ROC）曲线进行有效性分析。p 值<0.05 被认为具有统计学意义。
共纳入 113 例早期强直性脊柱炎患者（58 名女性/55 名男性）、57 名非炎症对照组个体（29 名女性/28 名男性）和 24 名炎症对照组个体（11 名女性/13 名男性）。强直性脊柱炎的病程时间为 10.9±7.1 个月。59 例患者至少存在 X 线片上某些等级的骶髂关节炎，但仅有 5 例符合放射学骶髂关节炎纽约标准。42%的患者人类白细胞抗原 B27（HLA-B27）阳性。在表现形式（轴性、周围性或混合性）或 HLA-B27 阳性方面，不同的强直性脊柱炎亚型间附着点评分无统计学差异。MASEI 评分在性别方面具有统计学意义。强直性脊柱炎患者的超声评分（均值±标准差）为 23.36±11.40，而非炎症对照组和炎症对照组分别为 12.26±6.85 和 16.04±9.94（p<0.001）。ROC 曲线下面积为 0.82，≥20 分的截断点具有 5.30 的似然比和 89.47%的特异性。
附着点在强直性脊柱炎早期就受到影响，且受累发生率在男性中更高，且与强直性脊柱炎的诊断亚型、HLA-B27 状态或表现形式无关。附着点超声评分似乎具有诊断准确性，可能有助于提高早期强直性脊柱炎的诊断准确性。
