摘要
目的改进1987年美国风湿病协会(ACR)修订的类风湿关节炎(RA)分类标准,探索Logistic回归分析在RA早期诊断中的应用。方法选取2009～2010年在国内14家三级甲等医院就诊,以关节炎症状为主要表现,病程小于1年的患者,共765例,其中RA患者514例,非RA患者251例。应用Logistic回归分析法筛选RA危险因素,将有统计学意义的危险因素应用Logistic回归分析构建诊断系统,计算RA早期诊断中的灵敏度和特异度。通过受试者工作特征(ROC)曲线下面积考核模型在早期RA诊断中的价值。结果多元Logistic回归分析筛选变量,共有8项指标纳入研究:晨僵时间至少持续1h、累及3个以上关节、腕关节,近端指间关节以及掌指关节受累、对称性关节受累、关节放射学改变、关节受累持续时间≥6周、RF和抗环瓜氨酸肽(CCP)抗体阳性。1987年ACR标准和Logistic回归分析得到的灵敏度分别为70.82%和94.16%;特异度分别为90.04%和74.50%;ROC曲线下面积(标准差)分别为0.821(0.015)和0.949(0.008)。结论应用Logistic回归分析可以建立合适的RA早期诊断模型。
Objective To revise the American College of Rheumatology classification criteria for the rheumatoid arthritis(RA) and explore the use of Logistic regression analysis in the diagnosis of early RA.Methods All patients from the 14 hospitals who had arthritis complaints in recent one year were enrolled.Patients were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.A total of 765 patients were included in the study.514 patients were diagnosed as RA and 251 were diagnosed as other rheumatic diseases.Backward logistic regression was done to choose significant variables.We calculated the sensitivity and specificity.The diagnostic performance of the prediction rule was evaluated using the area under the curve(AUC).Results The prediction model consisted of 8 variables:morning stiffness of ≥1 hour,arthritis in ≥3 joints,bilateral compression pain,swelling of the proximal interphalangeal,metacarpophalangeal,or wrist joints,radiographic erosions,last ≥6 weeks,rheumatoid factor positivity and anti-cyclic citrullinated peptide antibody positivity.The sensitivity of 1987 ACR criteria and Logistic regression analysis criteria was 70.82% and 94.16%,respectively.The specificity was 90.04% and 74.50%,respectively.The AUC(s) was 0.821(0.015) and 0.949(0.008),respectively.Conclusions Logistic regression analysis can be used as the early diagnostic method for RA.
出处
《中华临床医师杂志（电子版）》
CAS
2011年第10期2940-2945,共6页
Chinese Journal of Clinicians(Electronic Edition)
基金
"十一五"国家科技支撑计划项目(2008BAI59B01)
