应用共识方法确定系统性红斑狼疮分类标准的候选条目。
Use of Consensus Methodology to Determine Candidate Items for Systemic Lupus Erythematosus Classification Criteria.
机构信息
From the Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto; Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto; University Health Network, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan; University of California, Los Angeles, Los Angeles; University of California, San Francisco, California; Brigham and Women's Hospital, Boston; Harvard Medical School, Boston, Massachusetts; Medical University of South Carolina, Charleston, South Carolina; Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Hospital Clínic, Barcelona, Spain; AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, Paris; Université Paris Descartes-Sorbonne Paris Cité, Paris; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin; Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin; University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; National and Kapodestrian University of Athens, and Biomedical Research Foundation of the Athens Academy, Athens, Greece; Department of Medicine, University of Cambridge, Cambridge, UK; University of Pisa, Pisa, Italy; Medical University of Vienna, Vienna, Austria.
S.R. Johnson, MD, PhD, FRCPC, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto; D. Khanna, MD, MS, Division of Rheumatology, Department of Medicine, University of Michigan; R. Cervera, MD, PhD, FRCP, Hospital Clínic, Barcelona; N. Costedoat-Chalumeau, MD, PhD, AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, and Université Paris Descartes-Sorbonne Paris Cité, and INSERM U 1153, CRESS; D.D. Gladman, MD, FRCPC, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto; B.H. Hahn, MD, University of California, Los Angeles; F. Hiepe, MD, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Rheumatology and Clinical Immunology; J. Sánchez-Guerrero, MD, MSc, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; E. Massarotti, MD, Brigham and Women's Hospital, and Harvard Medical School; D.T. Boumpas, MD, FACP, FACR, National and Kapodestrian University of Athens, and Biomedical Research Foundation of the Athens Academy; K.H. Costenbader, MD, MPH, Brigham and Women's Hospital, and Harvard Medical School; D. Daikh, MD, University of California, San Francisco; D. Jayne, MD FRCP, FRCPE, FMedSci, Department of Medicine, University of Cambridge; T. Dörner, MD, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Rheumatology and Clinical Immunology; D.L. Kamen, MD, MSCR, Medical University of South Carolina; M. Mosca, MD, PhD, University of Pisa; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine; J.S. Smolen, MD, Medical University of Vienna; D. Wofsy, MD, University of California, San Francisco; M. Aringer, MD, University Medical Center and Faculty of Medicine Carl Gustav Carus, TU Dresden.
出版信息
J Rheumatol. 2019 Jul;46(7):721-726. doi: 10.3899/jrheum.180478. Epub 2018 Dec 15.
OBJECTIVE
Given the complexity and heterogeneity of systemic lupus erythematosus (SLE), high-performing classification criteria are critical to advancing research and clinical care. A collaborative effort by the European League Against Rheumatism and the American College of Rheumatology was undertaken to generate candidate criteria, and then to reduce them to a smaller set. The objective of the current study was to select a set of criteria that maximizes the likelihood of accurate classification of SLE, particularly early disease.
METHODS
An independent panel of international SLE experts and the SLE classification criteria steering committee (conducting SLE research in Canada, Mexico, United States, Austria, Germany, Greece, France, Italy, and Spain) ranked 43 candidate criteria. A consensus meeting using nominal group technique (NGT) was conducted to reduce the list of criteria for consideration.
RESULTS
The expert panel NGT exercise reduced the candidate criteria for SLE classification from 43 to 21. The panel distinguished potential "entry criteria," which would be required for classification, from potential "additive criteria." Potential entry criteria were antinuclear antibody (ANA) ≥ 1:80 (HEp-2 immunofluorescence), and low C3 and/or low C4. The use of low complement as an entry criterion was considered potentially useful in cases with negative ANA. Potential additive criteria included lupus nephritis by renal biopsy, autoantibodies, cytopenias, acute and chronic cutaneous lupus, alopecia, arthritis, serositis, oral mucosal lesions, central nervous system manifestations, and fever.
CONCLUSION
The NGT exercise resulted in 21 candidate SLE classification criteria. The next phases of SLE classification criteria development will require refinement of criteria definitions, evaluation of the ability to cluster criteria into domains, and evaluation of weighting of criteria.
目的
鉴于系统性红斑狼疮（SLE）的复杂性和异质性，高性能的分类标准对于推进研究和临床护理至关重要。欧洲抗风湿病联盟和美国风湿病学会进行了合作，制定了候选标准，然后将其简化为更小的一组。本研究的目的是选择一组最大限度提高 SLE 准确分类（尤其是早期疾病）可能性的标准。
方法
一个由国际 SLE 专家和 SLE 分类标准指导委员会（在加拿大、墨西哥、美国、奥地利、德国、希腊、法国、意大利和西班牙进行 SLE 研究）组成的独立小组对 43 项候选标准进行了评分。使用名义群体技术（NGT）进行了共识会议，以减少考虑标准的清单。
结果
专家小组的 NGT 练习将 SLE 分类的候选标准从 43 项减少到 21 项。该小组区分了潜在的“入选标准”，这是分类所必需的，以及潜在的“附加标准”。潜在的入选标准是抗核抗体（ANA）≥1:80（HEp-2 免疫荧光）和低 C3 和/或低 C4。在 ANA 阴性的情况下，使用低补体作为入选标准被认为具有潜在的用途。潜在的附加标准包括肾活检的狼疮肾炎、自身抗体、血细胞减少症、急性和慢性皮肤狼疮、脱发、关节炎、浆膜炎、口腔黏膜病变、中枢神经系统表现和发热。
结论
NGT 练习产生了 21 项候选 SLE 分类标准。SLE 分类标准制定的下一阶段将需要细化标准定义、评估将标准聚类到域中的能力以及评估标准的权重。
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