Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima City, Hiroshima, 730-8518, Japan.
Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan.
Rheumatol Int. 2020 Aug;40(8):1223-1227. doi: 10.1007/s00296-020-04535-2. Epub 2020 Feb 27.
Polyarteritis nodosa (PAN) is a potentially life-threatening systemic vasculitis, which predominantly involves medium arteries. However, it may be difficult to diagnose PAN in its early stage. The aim of our study was to investigate the sensitivity and specificity of the American College of Rheumatology (ACR) and the Japanese Ministry of Health, Labour and Welfare (MHLW) criteria for the diagnosis of PAN in a single-centre retrospective cohort in Japan and to develop simplified criteria with favourable diagnostic performance. All patients with "PAN" or "suspicion of PAN," as indicated on insurance forms, were included. The patient population was classified into PAN and non-PAN groups based on a retrospective chart review. The sensitivity and specificity of the ACR and MHLW criteria were calculated. Items that favourably discriminated the PAN group from the non-PAN group were determined and used as items for our provisional criteria. Thirteen cases of PAN and 24 cases without PAN were included in this study. The sensitivities of the ACR and MHLW criteria were 61.5% (8/13) and 30.8% (4/13), respectively, whereas the specificities were 79.2% (19/24) and 87.5% (21/24), respectively. We developed provisional criteria consisting of seven items, and found that a cut-off of ≥ 4 items had a sensitivity of 92.3% (12/13) and specificity of 91.7% (22/24) (p < 0.000001). The provisional seven-item criteria, developed in our real-world cohort of patients suspected of having PAN, had a high sensitivity and specificity and may be useful in the diagnosis of PAN, although it should be validated in additional patient populations.
结节性多动脉炎（PAN）是一种潜在危及生命的系统性血管炎，主要累及中等动脉。然而，在早期阶段诊断 PAN 可能具有挑战性。本研究旨在探讨日本单中心回顾性队列中美国风湿病学会（ACR）和日本厚生劳动省（MHLW）标准对 PAN 的诊断的敏感性和特异性，并制定具有良好诊断性能的简化标准。所有保险表上注明“PAN”或“疑似 PAN”的患者均被纳入研究。根据回顾性图表审查，将患者人群分为 PAN 组和非 PAN 组。计算 ACR 和 MHLW 标准的敏感性和特异性。确定有利于将 PAN 组与非 PAN 组区分的项目，并将其用作我们暂定标准的项目。本研究纳入了 13 例 PAN 患者和 24 例非 PAN 患者。ACR 和 MHLW 标准的敏感性分别为 61.5%（8/13）和 30.8%（4/13），特异性分别为 79.2%（19/24）和 87.5%（21/24）。我们制定了包含 7 项内容的暂定标准，发现≥4 项的截断值具有 92.3%（12/13）的敏感性和 91.7%（22/24）的特异性（p<0.000001）。在我们疑似患有 PAN 的真实世界患者队列中制定的暂定七项标准具有较高的敏感性和特异性，可能有助于 PAN 的诊断，尽管需要在其他患者人群中进行验证。
