Naidu Gsrsnk, Kopp Chirag Rajkumar, Sharma Vikas, Singhal Manphool, Pinto Benzeeta, Dhir Varun, Nada Ritambhra, Minz Ranjana W, Jain Sanjay, Sharma Aman
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, Indira Gandhi Medical College, Shimla, India.
Rheumatol Int. 2021 Sep;41(9):1651-1655. doi: 10.1007/s00296-021-04867-7. Epub 2021 Apr 27.
The 1990 American College of Rheumatology (ACR) criteria for the classification of polyarteritis nodosa (PAN) have many pitfalls and performed poorly when used for diagnostic purposes. Recently, a provisional seven-item diagnostic criteria for PAN was proposed. To validate the provisional seven-item diagnostic criteria for PAN in a cohort of PAN patients from a tertiary care centre in India. Clinical details of patients diagnosed as PAN as per the European Medicines Agency algorithm between 2005 and 2020 were collected retrospectively. Age and sex-matched anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) patients were included in the non-PAN group. Patients with a deficiency of adenosine deaminase 2 (DADA2) were included as a separate group. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for ACR criteria, the Ministry of Health, Labour and Welfare (MHLW) in Japan diagnostic criteria and the seven-item diagnostic criteria were calculated. Thirty-seven PAN, 14 DADA2 and 37 AAV patients were included in the analysis. The sensitivity, specificity, PPV and NPV of the seven-item criteria were 83.7%, 96.8%, 97.3% and 81.1% respectively. For the ACR criteria, sensitivity was 82.9% and specificity was 79.5%. The sensitivity, specificity for MHLW criteria were 77.3% and 90% respectively. The sensitivity and specificity of seven-item criteria for DADA2 patients were 58.8% and 88.2% respectively. There was very poor agreement between the ACR criteria and the seven-item and MHLW criteria and fair agreement between seven-item and MHLW criteria (κ = 0.279). The provisional seven-item criteria for PAN performed well with high specificity and PPV.
1990年美国风湿病学会（ACR）结节性多动脉炎（PAN）分类标准存在诸多缺陷，用于诊断时效果不佳。最近，有人提出了一项针对PAN的七项临时诊断标准。为了在印度一家三级医疗中心的PAN患者队列中验证该七项临时诊断标准。回顾性收集了2005年至2020年间根据欧洲药品管理局算法诊断为PAN的患者的临床细节。年龄和性别匹配的抗中性粒细胞胞浆抗体（ANCA）相关血管炎（AAV）患者被纳入非PAN组。腺苷脱氨酶2（DADA2）缺乏症患者被单独分组。计算了ACR标准、日本厚生劳动省（MHLW）诊断标准和七项诊断标准的敏感性、特异性、阳性和阴性预测值（PPV和NPV）。37例PAN患者、14例DADA2患者和37例AAV患者纳入分析。七项标准的敏感性、特异性、PPV和NPV分别为83.7%、96.8%、97.3%和81.1%。ACR标准的敏感性为82.9%，特异性为79.5%。MHLW标准的敏感性和特异性分别为77.3%和90%。七项标准对DADA2患者的敏感性和特异性分别为58.8%和88.2%。ACR标准与七项标准和MHLW标准之间的一致性很差，七项标准与MHLW标准之间的一致性一般（κ = 0.279）。PAN的七项临时标准表现良好，具有高特异性和PPV。
