系统性红斑狼疮国际协作临床分类标准的推导与验证
Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.
作者信息
Petri Michelle, Orbai Ana-Maria, Alarcón Graciela S, Gordon Caroline, Merrill Joan T, Fortin Paul R, Bruce Ian N, Isenberg David, Wallace Daniel J, Nived Ola, Sturfelt Gunnar, Ramsey-Goldman Rosalind, Bae Sang-Cheol, Hanly John G, Sánchez-Guerrero Jorge, Clarke Ann, Aranow Cynthia, Manzi Susan, Urowitz Murray, Gladman Dafna, Kalunian Kenneth, Costner Melissa, Werth Victoria P, Zoma Asad, Bernatsky Sasha, Ruiz-Irastorza Guillermo, Khamashta Munther A, Jacobsen Soren, Buyon Jill P, Maddison Peter, Dooley Mary Anne, van Vollenhoven Ronald F, Ginzler Ellen, Stoll Thomas, Peschken Christine, Jorizzo Joseph L, Callen Jeffrey P, Lim S Sam, Fessler Barri J, Inanc Murat, Kamen Diane L, Rahman Anisur, Steinsson Kristjan, Franks Andrew G, Sigler Lisa, Hameed Suhail, Fang Hong, Pham Ngoc, Brey Robin, Weisman Michael H, McGwin Gerald, Magder Laurence S
机构信息
Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 7500, Baltimore, MD 21205, USA.
出版信息
Arthritis Rheum. 2012 Aug;64(8):2677-86. doi: 10.1002/art.34473.
OBJECTIVE
The Systemic Lupus International Collaborating Clinics (SLICC) group revised and validated the American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) classification criteria in order to improve clinical relevance, meet stringent methodology requirements, and incorporate new knowledge regarding the immunology of SLE.
METHODS
The classification criteria were derived from a set of 702 expert-rated patient scenarios. Recursive partitioning was used to derive an initial rule that was simplified and refined based on SLICC physician consensus. The SLICC group validated the classification criteria in a new validation sample of 690 new expert-rated patient scenarios.
RESULTS
Seventeen criteria were identified. In the derivation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (49 versus 70; P = 0.0082) and had greater sensitivity (94% versus 86%; P < 0.0001) and equal specificity (92% versus 93%; P = 0.39). In the validation set, the SLICC classification criteria resulted in fewer misclassifications compared with the current ACR classification criteria (62 versus 74; P = 0.24) and had greater sensitivity (97% versus 83%; P < 0.0001) but lower specificity (84% versus 96%; P < 0.0001).
CONCLUSION
The new SLICC classification criteria performed well in a large set of patient scenarios rated by experts. According to the SLICC rule for the classification of SLE, the patient must satisfy at least 4 criteria, including at least one clinical criterion and one immunologic criterion OR the patient must have biopsy-proven lupus nephritis in the presence of antinuclear antibodies or anti-double-stranded DNA antibodies.
目的
系统性红斑狼疮国际协作临床组（SLICC）对美国风湿病学会（ACR）系统性红斑狼疮（SLE）分类标准进行修订和验证，以提高临床相关性，满足严格的方法学要求，并纳入有关SLE免疫学的新知识。
方法
分类标准源自一组702个由专家评分的患者病例。采用递归划分得出初始规则，并根据SLICC医生的共识进行简化和完善。SLICC组在一个由690个新的专家评分患者病例组成的新验证样本中对分类标准进行了验证。
结果
确定了17条标准。在推导集中，与当前的ACR分类标准相比，SLICC分类标准导致的错误分类更少（分别为49例和70例；P = 0.0082），敏感性更高（94%对86%；P < 0.0001），特异性相同（92%对93%；P = 0.39）。在验证集中，与当前的ACR分类标准相比，SLICC分类标准导致的错误分类更少（分别为62例和74例；P = 0.24），敏感性更高（97%对83%；P < 0.0001），但特异性更低（84%对96%；P < 0.0001）。
结论
新的SLICC分类标准在大量由专家评分的患者病例中表现良好。根据SLICC的SLE分类规则，患者必须满足至少4条标准，包括至少一条临床标准和一条免疫学标准，或者患者在存在抗核抗体或抗双链DNA抗体的情况下必须有经活检证实的狼疮性肾炎。
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