结合超声计数炎症关节的改良版DAS28的临床应用

原文

译文

[2011] [FRI0057] VALIDITY OF A MODIFIED VERSION OF THE DAS28 USING ULTRASOUND POWER DOPPLER A.M. Bertoli, M. Audisio, G. Py, M. Baravalle, L. Morales, I. Strusberg, A. Strusberg Instituto Reumatologico Strusberg, Córdoba, Argentina Background: Clinical instruments currently used to assess disease activity in rheumatoid arthritis (RA) do not seem to be specific enough to define the state of remission. The search of new instruments to assess remission is actually part of the current research agenda. Objectives: To evaluate the performance of a modified version of the DAS28 using ultrasound power Doppler (USPD), the DAS-USPD herein, to assess disease activity and remission in RA. Methods: We evaluated 82 RA patients fulfilling the 1987 ACR criteria. A modified version of the DAS28, the DAS-USPD, was calculated by replacing the swollen joint count by the USPD joint assessment of inflammation in 28 joints. The performance of the DAS-USPD to measure disease activity (construct validity) was calculated by its comparison with the DAS28, the CDAI and the ACR criteria for remission using the Spearman's rho test. The performance of the DAS-USPD to measure remission (concurrent validity) was obtained by classifying patient into remission versus active disease and comparing this modified version with the DAS28 and CDAI using a k test. Results: Among the 82 patients, 66 (80,5%) were female, with a mean age of 50,5 (SD 13,1) years and a median disease duration of 80,0 (25-75 percentile 45-127) months. The means value (SD) of the DAS-USPD, DAS28 and CDAI were 3.41 (1.51), 3.43 (1.68) and 12.08 (13.67), respectively. Twenty-five (30.5%) patients were classified into remission according to the DAS-USPD, 26 (31,7%) according to the DAS28, 19 (23,2%) according to the CDAI and 22 (26.8%) according to the ACR criteria for remission.   Table 1 depicts the construct and concurrent validity of the DAS-USDP. Table 1. Construct and concurrent validity of the DAS-USDP Validity of the DAS-PD DAS28 CDAI ACR criteria for remission Construct Convergent rho=0.97; p<0.001 rho=0.80; p<0.001 Divergent –0.75; p<0.001 Concurrent k=0.80; p<0.001 k=0.45; p<0.001 k=0.38; p=0.001 Conclusions: Our results show a good performance of the DAS-USPD to measure disease activity. Nevertheless, its capacity to discriminate remission versus activity its only moderate when compared with other clinical instruments such as the CDAI and the ACR criteria for remission. References: 1.        Mierau M, Schoels M, Gonda G, Fuchs J, Aletaha D, Smolen JS. Assessing remission in clinical practice. Rheumatology (Oxford) 2007; 46(6):975-9. 2.        Aletaha D, Smolen JS. Remission of rheumatoid arthritis: should we care about definitions? Clin Exp Rheumatol 2006; 24(6 Suppl 43):S-51. 3.        Molenaar ET, Voskuyl AE, Dinant HJ, Bezemer PD, Boers M, Dijkmans BA. Progression of radiologic damage in patients with rheumatoid arthritis in clinical remission. Arthritis Rheum 2004; 50(1):36-42. 4.        Aletaha D, Funovits J, Breedveld FC, Sharp J, Segurado O, Smolen JS. Rheumatoid arthritis joint progression in sustained remission is determined by disease activity levels preceding the period of radiographic assessment. Arthritis Rheum 2009; 60(5):1242-9. Disclosure of Interest: None Declared Citation: Ann Rheum Dis 2011;70(Suppl3):364

结合超声计数炎症关节的改良版DAS28的临床应用   Bertoli AM, et al. EULAR 2011. Present No: FRI0057.   背景: 目前评估类风湿关节炎(RA)疾病活动度的临床工具在定义缓解状态时的特异性不够好。开发评估缓解的新工具已经成为当前研究课题之一了。 目的: 评估一种结合多普勒超声(PD)的改良版DAS28(即DAS-USPD)的性能，并探讨它在评估RA病情活动和缓解中应用。 方法: 我们评价了82例符合1987年ACR分类标准的RA病人。将DAS28中体检计数的肿胀关节数替换为USPD计数的炎症关节数(28个关节)，由此就有了一个改良版的DAS28。通过与DAS28、CDAI以及ACR的缓解定义相比较，用Spearman rho检验分析DAS-USPD对疾病活动度的评估性能(建构效度)。通过将病人归类为缓解或疾病活动，并与DAS28、CDAI进行比较，用k检验来分析DAS-USPD对缓解的评估性能 (共时效度)。 结果: 在82例患者中，66例(5%)为女性，平均年龄为50.5岁(SD: 13.1)，病程中位数为80.0个月(25-75百分位数: 45-127)。DAS-USPD、DAS28以及CDAI的平均值(SD)分别为3.41 (1.51)，3.43 (1.68)和12.08 (13.67)。根据DAS-USPD判为缓解的病人有25例(30.5%)，获DAS28缓解的有26例(31.7%)，获CDAI缓解的有19例(23.2%)，达ACR缓解的有22例(26.8%)。   表1. DAS-USDP的建构效度和共时效度。 DAS-PD的效度 DAS28 CDAI ACR缓解标准 建构效度 收敛 rho=0.97; p<0.001 rho=0.80; p<0.001 发散 –0.75; p<0.001 共时效度 k=0.80; p<0.001 k=0.45; p<0.001 k=0.38; p=0.001     结论: 本研究显示DAS-USPD对RA疾病活动度有良好的判断性能。但是，与诸如CDAI和ACR的缓解标准等临床工具相比，它对疾病活动和缓解的鉴别能力仅能算作中等。

转载于:https://www.cnblogs.com/T2T4RD/archive/2011/09/01/5464258.html