Seeliger Benjamin, Sznajd Jan, Robson Joanna C, Judge Andrew, Craven Anthea, Grayson Peter C, Suppiah Ravi S, Watts Richard A, Merkel Peter A, Luqmani Raashid A
Department of Respiratory Medicine, Hannover Medical School, Hanover, Germany.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Rheumatology (Oxford). 2017 Jul 1;56(7):1154-1161. doi: 10.1093/rheumatology/kex075.
Advances in diagnostic techniques have led to better distinction between types of vasculitis, potentially affecting the utility of the 1990 ACR classification criteria for vasculitis. This study tested the performance of these criteria in a contemporary vasculitis cohort.
The Diagnosis and Classification in Vasculitis Study provided detailed clinical, serological, pathological and radiological data from patients with primary systemic vasculitis and clinical context-specific comparator conditions. Fulfilment of six ACR criteria sets and their diagnostic performance was evaluated in patients with a given type of vasculitis and its comparator conditions.
Data from 1095 patients with primary systemic vasculitis and 415 with comparator conditions were available. For classification, sensitivities and specificities for ACR classification criteria were, respectively, 81.1% and 94.9% for GCA; 73.6% and 98.3% for Takayasu's arteritis; 65.6% and 88.7% for granulomatosis with polyangiitis; 57.0% and 99.8% for eosinophilic granulomatosis with polyangiitis; 40.6% and 87.8% for polyarteritis nodosa; 28.9% and 88.5% for microscopic polyangiitis; and 72.7% and 96.3% for IgA-vasculitis. Overall sensitivity was 67.1%. Of cases identified by their respective criteria, 16.9% also met criteria for other vasculitides. Diagnostic specificity ranged from 64.2 to 98.9%; overall, 113/415 comparators (27.2%) fulfilled at least one of the ACR classification criteria sets.
Since publication of the ACR criteria for vasculitis, the sensitivity for each type of vasculitis, except GCA, has diminished, although the specificities have remained high, highlighting the need for updated classification criteria.
诊断技术的进步使得血管炎类型之间的区分更加清晰，这可能会影响1990年美国风湿病学会（ACR）血管炎分类标准的实用性。本研究在当代血管炎队列中测试了这些标准的性能。
血管炎诊断与分类研究提供了原发性系统性血管炎患者以及特定临床背景对照疾病患者详细的临床、血清学、病理学和放射学数据。在特定类型血管炎患者及其对照疾病中评估了六个ACR标准集的满足情况及其诊断性能。
有1095例原发性系统性血管炎患者和415例对照疾病患者的数据可供分析。就分类而言，ACR分类标准对巨细胞动脉炎（GCA）的敏感性和特异性分别为81.1%和94.9%；对大动脉炎的敏感性和特异性分别为73.6%和98.3%；对肉芽肿性多血管炎的敏感性和特异性分别为65.6%和88.7%；对嗜酸性肉芽肿性多血管炎的敏感性和特异性分别为57.0%和99.8%；对结节性多动脉炎的敏感性和特异性分别为40.6%和87.8%；对显微镜下多血管炎的敏感性和特异性分别为28.9%和88.5%；对IgA血管炎的敏感性和特异性分别为72.7%和96.3%。总体敏感性为67.1%。在各自标准确定的病例中，16.9%也符合其他血管炎的标准。诊断特异性范围为64.2%至98.9%；总体而言，415例对照疾病中有113例（27.2%）至少满足一项ACR分类标准集。
自ACR血管炎标准发布以来，除GCA外，每种血管炎类型的敏感性均有所下降，尽管特异性仍然很高，这突出表明需要更新分类标准。
