Nailfold capillaroscopy-how many fingers should be examined to detect abnormality?
Nailfold capillaroscopy-how many fingers should be examined to detect abnormality?
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DOI：
10.1093/rheumatology/key293
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发表时间：
2019-02-01
期刊：
影响因子：
5.5
通讯作者：
Herrick, Ariane L.
中科院分区：
文献类型：
--
作者：
Dinsdale, Graham;Roberts, Chris;Herrick, Ariane L.
目标。甲皱毛细支气管镜正越来越多地被风湿科医生用于诊断SSc。然而，在繁忙的门诊中，评估所有的甲皱可能会很耗时。我们的目的是回答这样一个问题，即临床医生应该定期评估多少(以及哪些)手指才能准确地捕捉到真实状态。这项分析纳入了173名参与者(101名SSC患者，22名初级RP患者和50名健康对照)1600张图像的2994项评估(由国际专家观察员小组进行)。然后对7个单指或手指组合(来自中指和无名指)进行了两个毛细血管异常标志物[巨大毛细血管的存在和SSC分级(早期、活跃或晚期)]的敏感性测试，并与所有8个手指的评估结果进行了比较。对于八指金标准，对诊断标准的敏感性为74.6%(仅有巨人存在的敏感性为53.0%，仅图像级别的敏感性为73.1%)。仅检查一个手指的灵敏度较低(从右中指31.7%到左指环46.6%)。检查两个无名指的敏感度为59.8%，而检查两个无名指和两个中指的四指组合的敏感度为66.7%。在常规的毛细支气管镜检查中，理想情况下应该检查所有的8个甲床(不包括拇指)，否则会漏掉一些异常。只检查四个手指可以降低毛细支气管镜检查的敏感性。
Objectives. Nailfold capillaroscopy is being increasingly used by rheumatologists in the diagnosis of SSc. However, assessment of all nailfolds can be time-consuming in a busy outpatient clinic. Our aim was to answer the question as to how many (and which) fingers a clinician should routinely assess to capture accurately the true state.Methods. A total of 2994 assessments (by an international panel of expert observers) of 1600 images from 173 participants (101 with SSc, 22 with primary RP and 50 healthy controls) were included in this analysis. Seven single-finger or finger combinations (derived from the middle and ring fingers) were then tested for sensitivity for the presence of two markers of capillary abnormality [presence of giant capillaries and an SSc grade (early, active or late)] compared with assessment of all eight fingers.Results. For the eight-finger gold standard, sensitivity against the diagnostic criteria was 74.6% (53.0% for the presence of giants alone and 73.1% for image grade alone). Examining only one finger gave low sensitivity (ranging from right middle 31.7% to left ring 46.6%). Examining both ring fingers gave a sensitivity of 59.8%, whereas examining the four-finger combination of both ring and both middle fingers gave a sensitivity of 66.7%.Conclusion. During routine capillaroscopic examination, ideally all eight nailbeds (excluding thumbs) should be examined, otherwise some abnormalities will be missed. Examining only four fingers reduces capillaroscopy sensitivity.