Stewart Julian A, Mailler-Burch Simone, Müller Darius, Studer Martina, von Känel Roland, Grosse Holtforth Martin, Schwegler Kyrill, Egloff Niklaus
Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Clinical Research, Bern University Hospital, University of Bern, Bern, Switzerland.
J Pain Res. 2019 Jul 10;12:2115-2124. doi: 10.2147/JPR.S205299. eCollection 2019.
Diagnostic criteria for fibromyalgia have been subject to debate and controversy for many years. The preliminary diagnostic criteria introduced in 2010 and 2011 have been criticized for different reasons, including questionable diagnostic specificity and a lack of an etiopathogenetic foundation. The "ABC indicators" presented in this study reflect a further development of the 2011 criteria and refer to (A) algesia, (B) bilateral, axial-symmetric pain distribution, and (C) chronic distress.
We compared the diagnostic performance of the ABC indicators with that of the 2011 criteria by analyzing the data of 409 inpatients with chronic functional pain divided into two subgroups of pain patients: Those with whole-body pain and those with pain not involving the whole body. Under the premise that FM phenotypically represents a whole-body pain disorder, sensitivity, specificity, correct classification and diagnostic odds ratios were calculated.
The 2011 criteria demonstrated a specificity of 68.1%, a sensitivity of 75.5%, a correct classification of 71.0% and a diagnostic odds ratio of 6.56 (CI: 4.17-10.31). The ABC indicators achieved a specificity of 88.3%, a sensitivity of 62.3%, a correct classification of 78.6%, and a diagnostic odds ratio of 12.47 (CI: 7.30-21.28).
The ABC fibromyalgia indicators demonstrated better specificity, lower sensitivity, and better overall diagnostic effectiveness than the original 2011 criteria.
纤维肌痛的诊断标准多年来一直存在争议。2010年和2011年引入的初步诊断标准因各种原因受到批评,包括可疑的诊断特异性和缺乏病因学基础。本研究中提出的“ABC指标”反映了2011年标准的进一步发展,指的是(A)痛觉过敏、(B)双侧、轴对称性疼痛分布以及(C)慢性痛苦。
我们通过分析409例慢性功能性疼痛住院患者的数据,将其分为两个疼痛患者亚组:全身疼痛患者和非全身疼痛患者,比较了ABC指标与2011年标准的诊断性能。在纤维肌痛在表型上代表一种全身疼痛性疾病的前提下,计算了敏感性、特异性、正确分类率和诊断比值比。
2011年标准的特异性为68.1%,敏感性为75.5%,正确分类率为71.0%,诊断比值比为6.56(95%置信区间:4.17 - 10.31)。ABC指标的特异性为88.3%,敏感性为62.3%,正确分类率为78.6%,诊断比值比为12.47(95%置信区间:7.30 - 21.28)。
与原始的2011年标准相比,ABC纤维肌痛指标显示出更好的特异性、更低的敏感性和更好的整体诊断效能。