2012 年系统性红斑狼疮国际协作组临床标准与 1997 年美国风湿病学会系统性红斑狼疮分类标准在真实世界场景中的表现。
Performance of the 2012 Systemic Lupus International Collaborating Clinics and the 1997 American College of Rheumatology classification criteria for systemic lupus erythematosus in a real-life scenario.
机构信息
Instituto Nacional de Cardiología Ignacio Chávez and Universidad Autónoma Metropolitana–Xochimilco, Mexico City, Mexico.
出版信息
Arthritis Care Res (Hoboken). 2015 Mar;67(3):437-41. doi: 10.1002/acr.22422.
OBJECTIVE
To evaluate the performance of the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria in classifying systemic lupus erythematosus (SLE) in an uncontrolled real-life scenario.
METHODS
Chart review study was performed in which each criterion from the 1997 American College of Rheumatology (ACR) and the 2012 SLICC criteria to classify SLE was applied to patients from an outpatient rheumatology clinic. The clinical diagnosis was used as the gold standard.
RESULTS
The sensitivity and specificity of the 2012 SLICC criteria were 92% and 99%, respectively, compared with the 1997 ACR criteria, which were 97% and 99%, respectively. The 2012 SLICC criteria were similar to the 1997 ACR criteria in terms of positive (98.9% versus 99%) and negative (92.5% versus 97.1%) predictive values as well as positive (92 versus 97) and negative (0.08 versus 0.03) likelihood ratios. A concordance of 0.96 (95% confidence interval [95% CI] 0.92–1.00) was observed between clinical diagnosis and the 1997 ACR criteria, while the concordance was 0.91 (95% CI 0.85–0.97) for the 2012 SLICC criteria. Seven SLE patients classified by the 1997 ACR criteria did not meet the 2012 SLICC criteria because of either the new definition for lymphopenia (2 patients) or the presence of isolated cutaneous involvement (5 patients), while 2 SLE patients who were classified by the 2012 SLICC criteria did not meet the 1997 ACR criteria because of either the presence of erosive arthritis or biopsy-proven nephritis with circulating antinuclear antibodies.
CONCLUSION
Overall, the 1997 ACR and the 2012 SLICC criteria are similar to classify SLE in an uncontrolled real-life scenario, although several new items contained in the 2012 SLICC criteria could represent a step forward for research purposes in selected clinical settings.
目的
评估 2012 年系统性红斑狼疮国际合作临床组（SLICC）标准在非控制的真实场景中分类系统性红斑狼疮（SLE）的性能。
方法
进行了图表回顾研究，其中将来自门诊风湿病诊所的患者应用于 1997 年美国风湿病学会（ACR）和 2012 年 SLICC 标准的每个标准来分类 SLE。临床诊断用作金标准。
结果
与 1997 年 ACR 标准相比，2012 年 SLICC 标准的敏感性和特异性分别为 92%和 99%，分别为 97%和 99%。2012 年 SLICC 标准在阳性（98.9%与 99%）和阴性（92.5%与 97.1%）预测值以及阳性（92%与 97%）和阴性（0.08 与 0.03）似然比方面与 1997 年 ACR 标准相似。观察到临床诊断与 1997 年 ACR 标准之间的一致性为 0.96（95%置信区间[95%CI]0.92-1.00），而对于 2012 年 SLICC 标准为 0.91（95%CI 0.85-0.97）。由于新的淋巴细胞减少症定义（2 例）或孤立性皮肤受累（5 例），7 例 SLE 患者按 1997 年 ACR 标准分类但不符合 2012 年 SLICC 标准，而 2 例 SLE 患者按 2012 年 SLICC 标准分类但不符合 1997 年 ACR 标准因为存在侵蚀性关节炎或活检证实的肾炎伴循环抗核抗体。
结论
总体而言，1997 年 ACR 和 2012 年 SLICC 标准在非控制的真实场景中分类 SLE 相似，尽管 2012 年 SLICC 标准中包含的几个新项目在某些临床环境下可能代表研究目的的一个进步。
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