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血管炎的分类及分类标准:成就、局限性与前景

Classification and classification criteria for vasculitis: achievements, limitations and prospects.

作者信息

Mahr Alfred, de Menthon Mathilde

机构信息

aDepartment of Internal Medicine, Hospital Saint-Louis bECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, University Paris Diderot, Paris, France.

出版信息

Curr Opin Rheumatol. 2015 Jan;27(1):1-9. doi: 10.1097/BOR.0000000000000134.

Abstract

PURPOSE OF REVIEW

The classification of diseases reveals the relationships between conditions that are linked in some way. Such classification has been a challenge for vasculitis because of the heterogeneous and protean nature of the illnesses. Classification criteria are critical to homogenize patient populations with vasculitis who are included in basic and clinical research studies.

RECENT FINDINGS

The most recent advance in vasculitis classification has been the revised 2012 Chapel Hill Consensus Conference (CHCC) nomenclature of vasculitis that, although mainly focusing on nomenclature, also included classification elements. Whereas still maintaining the caliber of the predominantly involved vessels as the main categorization criterion for primary systemic vasculitis, the 2012 CHCC nomenclature introduced a new category--variable-vessel vasculitis--to include Behçet's disease and Cogan's syndrome in the vasculitis spectrum. Another important feature was the expansion of the classification to secondary vasculitis and single-organ vasculitis. Similarly, classification criteria for several vasculitis entities have been altered and new criteria published, namely for Behçet's disease and cryoglobulinemic vasculitis.

SUMMARY

The classification of vasculitis continues to be amended to account for advances in the general understanding of the nature of vasculitis and our ability to diagnose them. The relevance of the prevailing classification system, relying on affected vessel size as the primary discriminator of vasculitis entities, is still questionable for clinical practice. Clinically sound, widely accepted classification criteria are available for most vasculitis entities, although some areas remain ill-defined: polyarteritis nodosa, microscopic polyangiitis and adult immunoglobulin A vasculitis (Henoch-Schönlein).

摘要

综述目的

疾病分类揭示了以某种方式相关的病症之间的关系。由于血管炎疾病具有异质性和多变性,其分类一直是一项挑战。分类标准对于使纳入基础和临床研究的血管炎患者群体同质化至关重要。

最新发现

血管炎分类的最新进展是2012年修订的查珀尔希尔共识会议(CHCC)血管炎命名法,该命名法虽然主要侧重于命名,但也包含了分类要素。2012年CHCC命名法在仍将主要受累血管的管径作为原发性系统性血管炎主要分类标准的同时,引入了一个新类别——可变血管炎,将白塞病和科根综合征纳入血管炎谱系。另一个重要特征是将分类扩展到继发性血管炎和单器官血管炎。同样,几种血管炎实体的分类标准也已更改并公布了新的标准,即白塞病和冷球蛋白血症性血管炎的标准。

总结

血管炎的分类不断修订,以适应对血管炎本质的总体认识进展以及我们对其进行诊断的能力。目前主要依靠受累血管大小作为血管炎实体主要鉴别依据的分类系统在临床实践中的相关性仍值得怀疑。虽然多数血管炎实体有临床合理且被广泛接受的分类标准,但仍有一些领域定义不明确:结节性多动脉炎、显微镜下多血管炎和成人免疫球蛋白A血管炎(过敏性紫癜)。

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