Milutinovic S, Radunovic G, Veljkovic K, Zlatanovic M, Zlatkovic Svenda M, Perovic Radak M, Pavlov Dolijanovic S, Stojic B, Damjanov Nemanja
Institute of Rheumatology, University of Belgrade, Serbia.
Department of Probability and Statistics, Faculty of Mathematics, University of Belgrade, Serbia.
Clin Exp Rheumatol. 2015 Nov-Dec;33(6):812-7. Epub 2015 Sep 7.
To distinguish patients (pts) with enthesitis having spondyloarthritis (SpA) from pts with enthesitis without SpA by ultrasound (US) enthesitis score.
The study sample included 127 pts with enthesitis (76 pts with SpA, 26 pts with rheumatoid arthritis, 25 pts with mechanically-related enthesitis). The entheses of plantar fascia, Achilles, patellar, quadriceps and common extensor tendon on lateral epicondyle were examined by US. Two operators, blinded to clinical diagnosis and enthesitis symptoms, assessed enthesis thickness, echogenicity, enthesophytes, power Doppler signal and erosions. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to determine the predictive value of each enthesitis lesion for diagnosis of SpA. The best predictive value for SpA was accomplished when absence and presence of increased thickness, hypoechogenicity and enthesophytes were scored as 0 and 1; absence and presence of PD and erosions were scored as 0 and 4. Belgrade Ultrasound Enthesitis Score (BUSES) represents a cumulative score of derived enthesitis lesion scores at examined entheses. Independent-samples t-test was used for BUSES comparison between pts with and without SpA. Validity of BUSES for SpA diagnosis was evaluated by sensitivity and specificity. Cut-off point was chosen as the smallest value with specificity of at least 90%. The reliability was analysed by intra-class-correlation coefficient (ICC).
BUSES was 9.9 ± 12.4 (mean ± SD) in SpA pts and 3.1 ± 4.2 in pts without SpA (p<0.001). BUSES cut-off point ≥ 7 achieved excellent specificity (90.2%) and fair sensitivity (47.4%). ICC was 0.99.
BUSES is highly specific, valid and reliable to identify patients with SpA.
通过超声（US）附着点炎评分，区分患有附着点炎的脊柱关节炎（SpA）患者与不患有SpA的附着点炎患者。
研究样本包括127例附着点炎患者（76例SpA患者、26例类风湿关节炎患者、25例机械性相关附着点炎患者）。通过超声检查足底筋膜、跟腱、髌腱、股四头肌和外侧上髁伸肌总腱的附着点。两名对临床诊断和附着点炎症状不知情的操作人员评估附着点厚度、回声性、骨赘、能量多普勒信号和侵蚀情况。采用逻辑回归和受试者工作特征（ROC）曲线分析来确定每个附着点炎病变对SpA诊断的预测价值。当厚度增加、低回声和骨赘的有无分别计为0和1，能量多普勒信号和侵蚀的有无分别计为0和4时，对SpA的预测价值最佳。贝尔格莱德超声附着点炎评分（BUSES）代表在检查的附着点处得出的附着点炎病变评分的累积分数。采用独立样本t检验对SpA患者和非SpA患者的BUSES进行比较。通过敏感性和特异性评估BUSES对SpA诊断的有效性。将截断点选为特异性至少为90%的最小值。通过组内相关系数（ICC）分析可靠性。
SpA患者的BUSES为9.9±12.4（平均值±标准差），非SpA患者为3.1±4.2（p<0.001）。BUSES截断点≥7时具有出色的特异性（90.2%）和尚可的敏感性（47.4%）。ICC为0.99。
BUSES在识别SpA患者方面具有高度特异性、有效性和可靠性。
