Development and evaluation of a musculoskeletal ultrasound-based prediction model for knee joint involvement in brucellosis

doi:10.19871/j.cnki.xfcrbzz.2026.04.005

Abstract

Abstract: Objective To explore the high risk factors of knee joint involvement in patients with brucellosis based on musculoskeletal ultrasound, to construct and verify the prediction model of knee joint involvement, and to provide theoretical support for early clinical screening, risk stratification and individualized intervention. Method A total of 132 patients with brucellosis who were admitted to the Second Hospital of Hohhot from October 2023 to October 2025 were enrolled, including 60 patients with knee joint involvement. General data and musculoskeletal ultrasound images were collected. Independent risk factors were screened by χ² test and Logistic regression analysis, and a prediction model was constructed. Bootstrap method was used for internal verification. The accuracy and clinical practicability of the prediction model were evaluated by receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, calibration curve, decision curve analysis (DCA), Shapley Additive Explanations (SHAP) and nomogram. Result Blood flow signal of infrapatellar fat pad and joint cavity / suprapatellar bursa effusion were independent risk factors (all P<0.05). The model was well distinguished and the calibration degree was high. The clinical net income was good when the threshold probability of DCA was 0.07-0.65. SHAP showed that the blood flow signal of infrapatellar fat pad contributed the most, followed by joint cavity / suprapatellar bursa effusion, both of which positively increased the risk. The prediction probability of the nomogram visualization model is 64.89%. Conclusion Blood flow signal of infrapatellar fat pad and joint cavity / suprapatellar bursa effusion is an independent risk factor for knee joint involvement in patients with brucellosis. The prediction model has the ability to predict the risk of knee joint involvement.

Key words: musculoskeletal ultrasound, Brucellosis, Knee joint involvement, Shapley additive explanations

CLC Number:

Qi Xiu, Ma Lingfeng, Li Ping. Development and evaluation of a musculoskeletal ultrasound-based prediction model for knee joint involvement in brucellosis[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(4): 30-35.

References

[1] 李慧东, 张文强, 尉瑞平, 等. 2014—2023年内蒙古自治区人间布鲁氏菌病监测及流行特征分析[J]. 中华地方病学杂志, 2025, 44(9): 741-745.
[2] Ghssein G, Ezzeddine Z, Tokajian S, et al.Brucellosis: Bacteriology, pathogenesis, epidemiology and role of the metallophores in virulence: a review[J]. Front Cell Infect Microbiol, 2025, 15: 1621230.
[3] Jin M, Fan Z, Gao R, et al.Research progress on complications of Brucellosis[J]. Front Cell Infect Microbiol, 2023, 13: 1136674.
[4] 段治宇. 内蒙古地区布鲁氏菌病关节炎的临床表现特点及伴发免疫学异常的相关性研究[D]. 呼和浩特:内蒙古医科大学, 2020.
[5] 辛雷, 苏佳灿. 膝关节功能评分:现状与展望[J]. 中国组织工程研究与临床康复, 2010, 14(39): 7367-7370.
[6] Koppikar S, Diaz P, Kaeley G S, et al.Seeing is believing: Smart use of musculoskeletal ultrasound in rheumatology practice[J]. Best Pract Res Clin Rheumatol, 2023, 37(1): 101850.
[7] 马创, 李国庆, 王云玲, 等. 布鲁氏菌性骨关节炎诊断和治疗专家共识[J]. 中国组织工程研究, 2026, 30(9): 2403-2412.
[8] 中华人民共和国国家卫生健康委员会. 布鲁氏菌病诊断(WS269-2019)[S]. 北京:中国标准出版社, 2019.
[9] 中国医师协会超声医师分会. 中国肌骨超声检查指南 [M]. 北京:人民卫生出版社, 2017.
[10] Adhitya I, Wibawa A, Aryana I, et al.Reliability, validity, and responsiveness of the Indonesian version of the Lysholm knee score and Tegner activity scale in patients with anterior cruciate ligament reconstruction[J]. J Bodyw Mov Ther, 2023, 34: 53-59.
[11] Collins N J, Misra D, Felson D T, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS),Tegner Activity Score (TAS) [J]. Arthritis Care Res (Hoboken), 2011, 63 Suppl 11(11): S208-S228.
[12] Wang J, Zhang Q.Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report[J]. BMC Infect Dis, 2022, 22(1): 430.
[13] Qiao J, Guo X, Zhang L, et al.Autologous platelet rich plasma injection can be effective in the management of osteoarthritis of the knee: impact on IL-1 β, TNF-α, hs-CRP[J]. J Orthop Surg Res, 2024, 19(1): 703.
[14] Liu B, Liu G, Ma X, et al.Epidemiology, clinical manifestations, and laboratory findings of 1,590 human brucellosis cases in Ningxia, China[J]. Front Microbiol, 2023, 14: 1259479.
[15] 张紫怡, 杨丽, 李新婷, 等. 布鲁氏菌病骨关节炎临床特征及易患因素分析[J]. 国际流行病学传染病学杂志, 2025, 52(2): 96-101.
[16] 朱桂英, 王春雨, 袁丁, 等. 299例布鲁氏菌病患者的临床特征分析[J]. 中华急诊医学杂志, 2025, 34(7): 977-981.
[17] 王登芹, 赵会丽, 张茜茜, 等. 布鲁氏菌病合并骨关节炎患者临床特征分析[J]. 中华地方病学杂志, 2024, 43(2): 137-140.
[18] 周心雨, 练锋, 陆翠红, 等. 超声黏弹性成像评估电针治疗膝骨关节炎患者髌下脂肪垫的研究[J]. 中国超声医学杂志, 2025, 41(10): 1181-1184.
[19] 武国华, 祁秀, 康孚嘉, 等. 基于超声彩色多普勒技术对布鲁氏菌病患者急性发作与肌腱及周围滑膜血流信号的相关性研究[J/ CD].新发传染病电子杂志, 2025,10(2):14-18.
[20] 白雪, 杨利娟, 王平阳. 肌骨超声在膝关节滑膜炎诊断中的应用价值及对关节腔积液、滑膜厚度的检出率分析[J]. 罕少疾病杂志, 2025, 32(6): 141-143.
[21] Konarski W, Derczyński M, Poboy k, et al. Exploring the link between brucellosis and osteonecrosis: A scoping review of current evidence[J]. Microb Pathog, 2025, 210: 108149.
[22] Elmas A, Ulutas F.Peripheral Arthritis and Tenosynovitis in a Patient With Brucellosis[J]. Cureus, 2023, 15(2): e35292.
[23] Qurat UL, Ain S, Islam Rather k u. Integrated statistical modeling and machine learning techniques with SHAP for epidemiological data analysis[J]. Ann Epidemiol, 2025, 108: 85-91.