目的 探讨2010年欧洲风湿病联盟和美国风湿病学会类风湿关节炎(RA)分类标准的敏感性和特异性.方法 回顾性分析304例具有关节症状的患者,规定开始改善病情的抗风湿药(DMARDs)治疗为RA确诊的金标准.分别用1987年及2010年RA分类标准对患者进行诊断,并与金标准进行比较.结果 根据金标准,有85例患者诊断为RA.其中,7例无关节肿胀,74例符合2010年RA分类标准,4例不符合.分析适合分类评分的95例患者,2010年分类标准诊断RA的敏感性和特异性分别为94.9%和88.2%,而1987年标准诊断RA的敏感性和特异性分别为73.1%和100.0%.当类风湿因子(RF)和(或)抗环瓜氨酸肽抗体(ACPA)均阴性时,2010年分类标准诊断RA的敏感性下降至50.0%.采用2010年标准对所有观察者评分进行受试者工作特征曲线分析,结果 显示该评分系统可适用于所有有关节症状的患者.结论 2010年分类标准具有较高的诊断敏感性,有助于早期诊断RA.%Objective To investigate the sensitivity and specificity of rheumatoid arthritis ( RA ) classification criteria by EULAR and ACR in 2010. Methods 304 patients with joint symptoms were retrospectively analyzed. DMARD starting to improve symptoms was taken as the gold standard of RA diagnosis. RA classification criteria of 1987 and 2010 were used to diagnose patients, and the results were compared with those diagnosed with gold standard. Results 85 patients were diagnosed as RA according to gold standard. Among these patients, 7 had no swollen joints, 74 were classified as RA under the 2010 criteria and 4 did not meet the standard. 95 patients that met the classification criteria were analyzed. The sensitivity and specificity under the 2010 criteria were 94. 9% and 88. 2% respectively, while the sensitivity and specificity under 1987 criteria were 73. 1% and 100. 0% respectively. The sensitivity of RA under 2010 criteria decreased to 50. 0% when both RF and ( or ) ACPA were negative. Receiver- operated characteristic ( ROC ) curve of the scoring was analyzed under 2010 criteria, and the result showed that this scoring system could be used in patients of all joint symptoms. Conclusion The 2010 classification criteria are helpful for distinguishing RA at an early stage with high sensitivity.
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