大动脉炎不同诊断或分类标准的临床诊断效能对比研究

A comparative study of diagnostic efficacy of different diagnostic/classification criteria in Takayasu arteritis

目的比较大动脉炎日本Ishikawa诊断标准、修正的日本诊断标准、美国风湿病学分类标准以及基于中国人群的诊断模型在中国大动脉炎患者中的临床诊断效能。方法纳入自2008年1月1日至2015年6月30日就诊于复旦大学附属中山医院风湿免疫科门诊和住院部的大动脉炎患者149例，同期累及主动脉或其分支的其他血管疾病患者126例。收集患者的一般特征、症状、体征以及实验室、影像学检查资料，比较不同诊断／分类标准／模型对大动脉炎患者诊断的敏感度、特异度、准确度以及受试者工作特征曲线下面积。结果在敏感度、特异度、准确度以及受试者工作特征曲线下面积方面，中国诊断模型分别为90．60％、80．95％及86．18％和85．80％，日本Ishikawa诊断标准分别为34．23％、99．21％、64．00％及66．70％，修正的日本诊断标准分别为84．13％、79．87％、81．82％及82．00％，美国风湿病学会（ACR）诊断分类标准分别为83．89％、83．33％、83．64％及83．60％。中国诊断模型、美国分类标准以及修正的日本诊断标准之间上述指标差异无统计学意义。敏感度最高的是中国标准，特异度最高的是Ishikawa标准，诊断效能最高的是中国标准，Ishikawa标准诊断效能明显低于其他3种标准。结论中国诊断模型基于中国人群建立，采用现代影像学技术，有较好的诊断效能。

Objective This study aimed to analyze and evaluate the diagnostic efficacy of Ishikawa＇s, the modified Ishikawa＇s criteria, 1990 American College of Rheumatology （ACR） classification criteria and the diagnostic model based on Chinese population in Chinese TA patients. Methods One hundred and forty-nine patients with Takayasu arteritis and 126 patients with other vascular disorders which involved aorta or its branches were recruited in this study. All the patients were admitted to the Department of rheumatism and Immunology clinic or inpatient department of Zhongshan Hospital affiliated to Fudan University from January 1^st, 2008 to June 31^st, 2015. General characteristics, clinical manifestations, laboratory results and imaging data of all the patients were collected. Sensitivity, specificity, accuracy and area under receiver operating characteristics （ROC） curve of different criteria were analyzed. Results Sensitivity, specificity, accuracy and area under ROC curve of Chinese diagnostic model were 90. 60%, 80. 95%, 86. 18%, and 85.80%, respectively, while those of Ishikawa criteria were 34. 23%, 99. 21%, 64. 00%, and 66. 70%, respectively. These four indicators of the modified Ishikawa criteria were 84. 13%, 79. 87%, 81.82%, and 82.00%, respectively and that of ACR criteria were 83.89%, 83.33%, 83.64%, and 83.60%, respectively. No significant difference was found between any two of Chinese diagnostic model, the modified Ishikawa criteria and ACR criteria in all the indicators. Sensitivity of Chinese diagnostic model was highest, while specificity of Ishikawa criteria was the highest. Among these four criteria, the diagnostic efficacy of Chinese model was the best and that of Ishikawa criteria was the worst. Conclusion Chinese diagnostic model, which is based on Chinese population and adopts advanced imaging modality, has better diagnostic efficacy.