Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York, United States.
Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York, and Hofstra Northwell School of Medicine, Hempstead, New York, United States.
Arthritis Care Res (Hoboken). 2020 Nov;72(11):1597-1601. doi: 10.1002/acr.24057.
Different classification criteria for systemic lupus erythematosus (SLE) have been proposed for many years. The most widely used and accepted criteria has been the 1997 American College of Rheumatology (ACR) criteria. In 2012, the Systemic Lupus International Collaborating Clinics (SLICC) criteria were published in an attempt to improve the clinical relevance of SLE criteria. In 2017, weighted criteria were proposed that included entry criteria, something the 1997 ACR and the 2012 SLICC criteria did not identify. The aim of the present study was to validate the 2017 weighted criteria, the 1997 ACR criteria, and the 2012 SLICC criteria and compare the sensitivities and specificities in pediatric SLE.
For the past 15 years, retrospective chart review of patients diagnosed with SLE before age 19 years was conducted. The controls were patients referred for serologies positive for antinuclear antibodies but did not fulfill criteria for diagnosis of SLE at the initial visit or were diagnosed with another autoimmune disease. The 3 classification criteria sets were applied to these patients and compared against a gold standard of physician diagnosis.
A total of 156 patients were diagnosed with SLE. The sensitivity for the 2017 weighted criteria was 0.974 (95% confidence interval [95% CI] 0.936-0.993) and the specificity was 0.984 (95% CI 0.966-0.994). The sensitivity for the 1997 ACR criteria was 0.872 (95% CI 0.809-0.920) and the specificity was 1.00 (95% CI 0.990-1.000). The sensitivity for the 2012 SLICC criteria was 0.974 (95% CI 0.936-0.993) and the specificity was 0.997 (95% CI 0.985-1.000).
The 2017 weighted criteria and the 2012 SLICC criteria were more sensitive than the 1997 ACR criteria. There were no significant differences in sensitivity and specificity between the 2012 SLICC and the 2017 weighted criteria.
多年来，人们提出了多种系统性红斑狼疮（SLE）的分类标准。应用最广泛且被广泛接受的标准是 1997 年美国风湿病学会（ACR）标准。2012 年，国际狼疮协作组（SLICC）标准发表，旨在提高 SLE 标准的临床相关性。2017 年，提出了加权标准，其中包括纳入标准，这是 1997 年 ACR 和 2012 年 SLICC 标准未确定的。本研究旨在验证 2017 年加权标准、1997 年 ACR 标准和 2012 年 SLICC 标准，并比较在儿科 SLE 中的敏感性和特异性。
在过去的 15 年中，对 19 岁以下被诊断为 SLE 的患者进行了回顾性病历审查。对照组为因抗核抗体阳性而就诊但在初次就诊时未达到 SLE 诊断标准或被诊断为其他自身免疫性疾病的患者。将这 3 组分类标准应用于这些患者，并与医生诊断的金标准进行比较。
共诊断出 156 例 SLE 患者。2017 年加权标准的敏感性为 0.974（95%置信区间[95%CI]0.936-0.993），特异性为 0.984（95%CI 0.966-0.994）。1997 年 ACR 标准的敏感性为 0.872（95%CI 0.809-0.920），特异性为 1.00（95%CI 0.990-1.000）。2012 年 SLICC 标准的敏感性为 0.974（95%CI 0.936-0.993），特异性为 0.997（95%CI 0.985-1.000）。
2017 年加权标准和 2012 年 SLICC 标准比 1997 年 ACR 标准更敏感。2012 年 SLICC 标准和 2017 年加权标准在敏感性和特异性方面无显著差异。
