Takagi Yukinori, Sumi Misa, Nakamura Hideki, Iwamoto Naoki, Horai Yoshiro, Kawakami Atsushi, Nakamura Takashi
Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry and Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Rheumatology (Oxford). 2014 Nov;53(11):1977-83. doi: 10.1093/rheumatology/keu238. Epub 2014 Jun 6.
In this study we evaluated US as an additional classification item in the ACR classification of SS.
Of 581 patients classified as either SS (n = 364) or non-SS (n = 217) based on the minimum requirements of the American-European Consensus Group (AECG) classification, 184 patients (102 SS and 82 non-SS) who had scored two or more positive or two or more negative results according to the ACR criteria were selected. The AECG classification was used as the gold standard. A parotid and/or submandibular gland that was assigned a score ≥G1 was designated as SS positive. We evaluated US alone or with varying combinations of the ACR classification items in the diagnosis of SS.
The ACR criteria diagnosed the 184 patients with 91% sensitivity, 90% specificity and 91% accuracy. US alone diagnosed the 184 ACR patients with 79% sensitivity, 90% specificity and 83% accuracy, which was comparable to the results of US diagnosis in the AECG cohort (81%, 86% and 83%, respectively). Incorporating the US criteria as an alternative to one of the three ACR classification items achieved 89-91% sensitivity, 87-96% specificity and 89% or 92% accuracy, which was comparable to that of the original ACR classification. Furthermore, kappa analysis indicated that the results of the original ACR and US-replaced ACR classifications matched completely (κ = 0.960-0.974).
These results suggest that US can be used as an alternative to any of the three ACR classification items.
在本研究中，我们评估了超声作为干燥综合征美国风湿病学会（ACR）分类中的一项附加分类指标。
根据欧美共识小组（AECG）分类的最低要求，将581例患者分为干燥综合征组（n = 364）或非干燥综合征组（n = 217），选择了184例根据ACR标准获得两个或更多阳性或两个或更多阴性结果的患者（102例干燥综合征患者和82例非干燥综合征患者）。AECG分类用作金标准。将评分≥G1的腮腺和/或下颌下腺指定为干燥综合征阳性。我们评估了单独使用超声或与ACR分类指标的不同组合在干燥综合征诊断中的作用。
ACR标准诊断这184例患者的敏感性为91%，特异性为90%，准确性为91%。单独使用超声诊断这184例ACR患者的敏感性为79%，特异性为90%，准确性为83%，这与AECG队列中的超声诊断结果相当（分别为81%、86%和83%）。将超声标准作为ACR三个分类指标之一的替代指标，敏感性为89 - 91%，特异性为87 - 96%，准确性为89%或92%，这与原始ACR分类相当。此外，kappa分析表明，原始ACR和超声替代ACR分类的结果完全匹配（κ = 0.960 - 0.974）。
这些结果表明，超声可作为ACR三个分类指标中任何一个的替代指标。
