Medical Cell BioPhysics Group, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands; Department of Rheumatology, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
Department of Rheumatology, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
Joint Bone Spine. 2023 Dec;90(6):105611. doi: 10.1016/j.jbspin.2023.105611. Epub 2023 Jul 11.
We studied the performance of Raman spectroscopy integrated with polarized light microscopy (iRPolM) as a next-generation technique for synovial fluid analysis in gout.
This is a prospective study, including consecutive synovial fluid samples drawn from any peripheral swollen joint. Diagnostic accuracy was compared to the 2015 ACR/EULAR Gout classification criteria as a reference test and to polarized light microscopy (PLM) analysis by a rheumatologist. Synovial fluid was analysed with iRPolM after unblinding the PLM results.
Two hundred unselected consecutive patient samples were included in this study. Validation against clinical criteria: 67 patients were classified as gout according to 2015 ACR/EULAR classification criteria. Compared to the 2015 ACR/EULAR gout classification criteria, iRPolM had a sensitivity of 77.6% (95% CI: 65.8-86.9), specificity of 97.7% (95% CI: 93.5-99.5), positive predictive value (PPV) of 94.5% (95% CI: 84.9-98.2), negative predictive value (NPV) of 89.7% (95% CI: 84.7-93.1), an accuracy of 91.0% (95% CI: 86.2-94.6), a positive likelihood ratio of 34.4 (95% CI: 11.16-106.10) and a negative likelihood ratio of 0.23 (95% CI: 0.15-0.36). Validation against PLM: 55 samples were positive for MSU according to PLM. The interrater agreement between PLM and iRPolM was near perfect (к=0.90). The sensitivity of iRPolM to identify MSU in PLM-positive samples was 91.2% (95% CI: 80.7-97.1), the specificity was 97.6% (95% CI: 93.0-99.5), the PPV was 94.6% (95% CI: 85.0-98.2), NPV was 96.0% (95% CI: 91.2-98.2) and the accuracy was 95.6% (95% CI: 91.4-98.2). The positive likelihood ratio was 37.4 (95% CI: 12.20-114.71), and the negative likelihood ratio was 0.09 (95% CI: 0.04-0.21).
iRPolM is a promising next-generation diagnostic tool for rheumatology by diagnosing gout with high specificity, increased objectivity, and a sensitivity comparable to PLM.
我们研究了拉曼光谱与偏振光显微镜集成（iRPolM）作为痛风关节滑液分析的下一代技术的性能。
这是一项前瞻性研究，纳入了任何外周肿胀关节抽取的连续滑液样本。诊断准确性与 2015 年 ACR/EULAR 痛风分类标准（作为参考测试）和风湿病学家进行的偏振光显微镜（PLM）分析进行了比较。在对 PLM 结果进行去盲后，使用 iRPolM 对滑液进行分析。
本研究纳入了 200 例未经选择的连续患者样本。与临床标准的验证：根据 2015 年 ACR/EULAR 分类标准，67 例患者被分类为痛风。与 2015 年 ACR/EULAR 痛风分类标准相比，iRPolM 的敏感性为 77.6%（95%CI：65.8-86.9），特异性为 97.7%（95%CI：93.5-99.5），阳性预测值（PPV）为 94.5%（95%CI：84.9-98.2），阴性预测值（NPV）为 89.7%（95%CI：84.7-93.1），准确性为 91.0%（95%CI：86.2-94.6），阳性似然比为 34.4（95%CI：11.16-106.10），阴性似然比为 0.23（95%CI：0.15-0.36）。与 PLM 的验证：根据 PLM，55 份样本为 MSU 阳性。PLM 和 iRPolM 之间的观察者间一致性接近完美（к=0.90）。iRPolM 识别 PLM 阳性样本中 MSU 的敏感性为 91.2%（95%CI：80.7-97.1），特异性为 97.6%（95%CI：93.0-99.5），PPV 为 94.6%（95%CI：85.0-98.2），NPV 为 96.0%（95%CI：91.2-98.2），准确性为 95.6%（95%CI：91.4-98.2）。阳性似然比为 37.4（95%CI：12.20-114.71），阴性似然比为 0.09（95%CI：0.04-0.21）。
iRPolM 是一种有前途的下一代诊断工具，可通过高特异性、增加客观性和与 PLM 相当的敏感性来诊断痛风。
