基于肌骨超声指标的退行性膝关节炎与类风湿关节炎鉴别模型的构建及验证-现代医学

基于肌骨超声指标的退行性膝关节炎与类风湿关节炎鉴别模型的构建及验证

单位：1. 深圳市宝安区中医院超声科, 广东深圳 518000;
2. 深圳市宝安区中医院灵芝园社康全科医学科, 广东深圳 518000;
3. 深圳市宝安区中医院骨科, 广东深圳 518000;
4. 深圳市宝安区中医院风湿病科, 广东深圳 518000

关键词：退行性膝关节炎类风湿关节炎鉴别肌骨超声列线图

分类号：R684.3

出版年·卷·期（页码）：2025·53·第七期（1102-1109）

摘要：

目的：探讨退行性膝关节炎与类风湿关节炎的独立差异因素，基于差异因素构建鉴别诊断退行性膝关节炎与类风湿关节炎的列线图。方法：选取2022年2月至2024年9月于深圳市宝安区中医院就诊的240例关节炎患者作为建模组，其中退行性膝关节炎组与类风湿关节炎组各120例；依照近似7∶3比例选取103例关节炎患者作为验证组，建模组与验证组为随机分组，收集患者临床资料并进行肌骨超声检查。采用多因素Logistic回归分析筛选退行性膝关节炎与类风湿关节炎的独立差异因素，采用R语言中rms包构建鉴别诊断列线图，Hosmer-Lemeshow检验、校正曲线、受试者工作特征(ROC)曲线分别评估模型拟合效果、一致性、区分度，采用决策曲线分析列线图的临床效用及净收益。结果：建模组和验证组临床资料性别、红细胞沉降率、关节软骨改变等比较差异均无统计学意义(P＞0.05)。类风湿关节炎组IgM-RF、滑膜厚度及半月板损伤、血痂形成、腘窝囊肿、滑膜内血流信号Ⅱ～Ⅲ级比例高于退行性膝关节炎组(P＜0.05)。IgM-RF、滑膜厚度、半月板损伤、血痂形成、腘窝囊肿、滑膜内血流信号是退行性膝关节炎与类风湿关节炎之间的独立差异因素。模型内验证：Hosmer-Lemeshow检验χ²=5.186，P=0.737，校正曲线显示模型的实际曲线与理想曲线走形基本一致，ROC曲线的AUC为0.884(95%CI 0.841~0.927)，模型拟合效果、一致性良好、区分度良好；模型外验证：Hosmer-Lemeshow检验 χ²=9.844，P=0.276，校正曲线显示模型的实际曲线与理想曲线走形基本一致，ROC曲线的AUC为0.868(95%CI 0.821~0.915)。当高风险阈值概率范围在0.12～0.95时，使用该列线图鉴别诊断退行性膝关节炎与类风湿关节炎可获得较大的标准净收益。结论：基于肌骨超声指标构建的列线图对退行性膝关节炎与类风湿关节炎有较高的鉴别价值。

Objective:To explore the independent differential factors between degenerative knee arthritis and rheumatoid arthritis, and to construct a nomogram for differential diagnosis of degenerative knee arthritis and rheumatoid arthritis based on the differential factors.Methods:From February 2022 to September 2024, 240 arthritis patients who visited Shenzhen Bao'an District Hospital of Traditional Chinese Medicine were enrolled in the modeling group, including 120 cases of degenerative knee arthritis and 120 cases of rheumatoid arthritis, while 103 arthritis patients were selected as the validation group in an approximately 7∶3 ratio, the modeling group and validation group are randomly grouped. The patient's clinical data was collected and muscle bone ultrasound examination was performed. Multivariate logistic regression analysis was applied to screen for independent differential factors between degenerative knee arthritis and rheumatoid arthritis. RMS package in R language was used to construct a differential diagnostic nomogram. Hosmer-Lemeshow test, calibration curve, and ROC curve were applied to evaluate the fitting effect, consistency, and discriminability of the model. The decision curve was applied to analyze the clinical utility and net benefit of the nomogram. Results:There was no statistically obvious difference in gender, erythrocyte sedimentation rate, and joint cartilage changes between the modeling group and the validation group(P>0.05). The IgM RF, synovial thickness, proportions of meniscus injury, scab formation, popliteal cyst, and grade Ⅱ-Ⅲ blood flow signals in the rheumatoid arthritis group were higher than those in the degenerative knee arthritis group(P<0.05). IgM-RF, synovial thickness, meniscus injury, scab formation, popliteal cyst, and synovial blood flow signals were independent differential factors between degenerative knee arthritis and rheumatoid arthritis. Validation within the model: Hosmer-Lemeshow test showed χ²=5.186, P=0.737, the calibration curve showed that the actual curve of the model was basically consistent with the ideal curve, the AUC of the ROC curve was 0.884(95%CI 0.841-0.927), indicating good model fitting, consistency, and discriminability. Verification outside the model: Hosmer-Lemeshow test showed χ²=9.844, P=0.276, the calibration curve showed that the actual curve of the model was basically consistent with the ideal curve, and the AUC of the ROC curve was 0.868(95%CI 0.821-0.915). When the probability range of the high-risk threshold was between 0.12 and 0.95, the nomogram could achieve an obvious standard net benefit in the differential diagnosis of degenerative knee arthritis and rheumatoid arthritis. Conclusion:The nomogram constructed based on musculoskeletal ultrasound indicators has high differential value between degenerative knee arthritis and rheumatoid arthritis.

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