ANA阳性结果在门诊风湿病诊断中的预测

C. Chu, L. Ho, C. Mok
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引用次数: 0

摘要

目的:研究抗核抗体(ANA)阳性对门诊风湿病诊断的预测价值。方法:对2014年7月至2015年6月期间因ANA阳性而转诊至风湿病门诊的患者进行回顾性分析。除了ANA阳性外,还记录了出现的症状以及是否做出了最终的风湿病诊断。评估了ANA阳性及其滴度对风湿病诊断的阳性预测价值,包括是否伴有症状。结果:共纳入230名患者(82%为女性,年龄47.7±14.1岁[范围18-84])。家庭医学和普通门诊是转诊的主要来源(32.2%),其次是眼科(13.0%)和耳鼻喉科(11.7%)。54名(23.5%)患者最终被诊断为风湿病,类风湿性关节炎是最常见的诊断(40.7%)。在没有任何相关症状的情况下,ANA阳性的预测值为0%。雷诺现象(100%)、关节肿胀(59.5%)和关节僵硬(48.9%)的存在预示着更好的风湿病最终诊断以及ANA阳性。ANA滴度为1:80或更低对风湿性疾病的敏感性较低。受试者操作特征(ROC)曲线分析显示,[公式:见正文]1:128的ANA滴度最能预测风湿病诊断(AUC 0.78[0.71–0.85];灵敏度0.78;特异性0.64)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prediction of a Positive ANA Result for a Rheumatological Diagnosis in an Outpatient Setting
Objective: To study the predictive value of a positive anti-nuclear antibody (ANA) for a rheumatological diagnosis in an outpatient setting. Methods: Individuals who were referred to the rheumatology outpatient clinics because of a positive ANA between July 2014 and June 2015 were retrospectively reviewed. Presenting symptoms in addition to a positive ANA and whether a final rheumatological diagnosis was made were recorded. The positive predictive value of a positive ANA and its titer for a rheumatological diagnosis, with and without accompanying symptoms was evaluated. Results: A total of 230 patients were included (82% women, age 47.7 ± 14.1 years [range 18-84]). Family medicine and the general outpatient clinic were the main sources of referral (32.2%), followed by ophthalmology (13.0%) and otorhinolaryngology (11.7%). A final rheumatological diagnosis was made in 54 (23.5%) patients, with rheumatoid arthritis being the commonest diagnosis (40.7%). In the absence of any associated symptoms, the predictive value of a positive ANA was 0%. The presence of Raynaud’s phenomenon (100%), joint swelling (59.5%), and joint stiffness (48.9%) predicted a better final rheumatological diagnosis along with a positive ANA. ANA titers of 1:80 or less had a low sensitivity for rheumatic diseases. A receiver operating characteristic (ROC) curve analysis showed that an ANA titer of [Formula: see text]1:128 best predicted a rheumatological diagnosis (AUC 0.78 [0.71–0.85]; sensitivity 0.78; specificity 0.64). Conclusions: To improve the prediction for a rheumatological diagnosis, referral for a positive ANA test should be more appropriately done with compatible symptoms.
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