RELIABILITY AND VALIDITY OF 6 SYSTEMS FOR THE CLINICAL-ASSESSMENT OF DISEASE-ACTIVITY IN SYSTEMIC LUPUS-ERYTHEMATOSUS
RELIABILITY AND VALIDITY OF 6 SYSTEMS FOR THE CLINICAL-ASSESSMENT OF DISEASE-ACTIVITY IN SYSTEMIC LUPUS-ERYTHEMATOSUS
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DOI：
10.1002/anr.1780320909
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发表时间：
1989-09-01
影响因子：
--
通讯作者：
SCHUR, PH
中科院分区：
文献类型：
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作者：
LIANG, MH;SOCHER, SA;SCHUR, PH
对25例系统性红斑狼疮(SLE)患者进行了6种定义和评估疾病活动的系统(ROPES系统、美国国立卫生研究院(NIH)系统、纽约特殊外科医院系统、不列颠群岛狼疮评估组织[BILAG]量表、多伦多大学SLE疾病活动指数[SLE-DAI]和系统性狼疮活动测量[SLAM])的测试。患者分别由2名内科医生进行2次独立评估，时间间隔约1个月。患者之间的差异显示出分数差异的最大来源，根据工具的不同，占总差异的56%-84%。医生之间的差异(即差错)显示出第二大的差异，占总差异的11%-28%，而就诊之间的差异占总差异的5%-16%。BILAG、SLE-DAI和SLAM具有最好的访问间和评分者间可靠性。不同工具之间的得分具有较强的相关性(r=0.81~0.97)，具有趋同效度。所有工具都与医生对疾病的临床印象高度相关，但与他们对疾病严重程度的评估不太相关。患者符合的美国风湿病协会SLE标准的数量与医生的整体评估和仪器的分数相关性很差。患者自我报告的疾病活动得分与医生对疾病活动的评价高度相关(r=0.85~0.91)，且自我报告的平均值与医生对疾病活动的评价的平均值基本相同。相比之下，自我报告和医生评估之间的严重程度得分相关性较差(r=0.49-0.69)，并且自我报告的严重程度平均值低于医生的平均值。在临床研究中，BILAG、SLE-DAI和SLAM系统似乎比其他系统具有更好的心理测量学特性。
Six systems for defining and evaluating disease activity in patients with systemic lupus erythematosus (SLE) (the Ropes system, the National Institutes of Health [NIH] system, the New York Hospital for Special Surgery system, the British Isles Lupus Assessment Group [BILAG] scale, the University of Toronto SLE Disease Activity Index [SLE-DAI], and the Systemic Lupus Activity Measure [SLAM]) were tested on 25 SLE patients who were selected to represent a range of disease activity. The patients were evaluated independently by 2 physicians on 2 occasions approximately 1 month apart. Differences between patients demonstrated the largest source of variation in scores, accounting for 56-84% of the total variance, depending on the instrument. Differences between physicians (i.e., error) showed the next largest variation, 11-28% of the total variance, and differences between visits made up 5-16% of the total. The BILAG, SLE-DAI, and SLAM had the best inter-visit and inter-rater reliability. Convergent validity was shown by the strong correlations of scores among the different instruments (r = 0.81-0.97). All instruments correlated highly with the physicians'' clinical impression of disease but less well with their evaluation of disease severity. The number of American Rheumatism Association criteria for SLE that were met by the patients correlated poorly with the physicians'' global evaluation and with the scores of the instruments. The patients'' self-reported disease activity scores correlated highly with the physicians'' assessments of disease activity (r = 0.85-0.91), and the mean values from self-reports and from physicians'' assessments were nearly equal. In contrast, severity scores correlated less well between self-reports and physician assessments (r = 0.49-0.69), and mean self-reported severity values were lower than the means from physicians. The BILAG, SLE-DAI, and SLAM systems appear to have better psychometric properties than the others for clinical research.