Fazeli Bahare, Poredos Pavel, Schernthaner Gerit, Stephen Edwin, Kozak Matija, Catalano Mariella, Pecsvarady Zsolt, Patel Malay, Al Salman Mussaad Mohammaed, Altarazi Louay, Muhammad Bashar Abul Hasan, Chua Benjamin, Cvjetko Ivan, Desai Sanjay, Erer Dilek, Hussein Emad, Gaddikeri Phaniraj, Ionac Mihai, Iwai Takehisa, Karahan Oguz, Kota Albert, Kroger Knut, Kumar Prabhu Prem, Malecki Rafal, Marcoccia Antonella, Pandey Sandeep Raj, Ravari Hassan, Samuel Vimalin, Selvaraj Dheepak, Sermsathanasawadi Nuttawut, Sharebiani Hiva, Szuba Andrzej, Taheri Hossein, Zor Mustafa Hakan, Liew Aaron
Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia.
Ann Vasc Surg. 2022 Sep;85:211-218. doi: 10.1016/j.avsg.2022.03.028. Epub 2022 Apr 6.
Buerger's disease (BD) remains a debilitating condition. Despite multiple published diagnostic criteria for BD, none is universally accepted as a gold standard.
We conducted a 2-round modified Delphi consensus study to establish a consensus on the diagnostic. The questionnaire included statements from several commonly used diagnostic criteria for BD. Qualitative and quantitative analysis methods were performed. An agreement level of 70% was applied.
Twenty nine experts from 18 countries participated in this study. Overall, 75 statements were circulated in Round 1. Of these, 28% of statements were accepted. Following comments, 21 statements were recirculated in Round 2 and 90% were accepted. Although more than 90% of the experts did not agree that the diagnosis of BD can be based only on clinical manifestation, none of the nonclinical manifestations of BD were agreed as a part of the diagnostic criteria. There was an agreement that a history of tobacco consumption in any form, not necessarily confined to the current use, should be a part of the diagnostic criteria of BD. The history of thrombophlebitis migrans, even if not present at presentation, was accepted as a clue for BD diagnosis. It was also agreed that discoloration of the toes or fingers could be included in the diagnostic criteria of BD. Experts agreed that histology results could differentiate BD from atherosclerosis obliterans and other types of vasculitis. The presence of corkscrew collaterals on imaging and burning pain reached the agreement at the first round but not at the second. There was no consensus regarding age cut-off, the requirement of normal lipid profile, and normal blood glucose for BD diagnosis.
The present study demonstrated discrepancies in the various published diagnostic criteria for BD and their selective utilization in routine clinical practice worldwide. We propose that all published diagnostic criteria for BD be re-evaluated for harmonization and universal use.
血栓闭塞性脉管炎（BD）仍是一种使人衰弱的疾病。尽管已发表了多种BD的诊断标准，但没有一种被普遍接受为金标准。
我们进行了两轮改良的德尔菲共识研究，以就诊断达成共识。问卷包括BD几种常用诊断标准中的陈述。采用定性和定量分析方法。应用70%的一致水平。
来自18个国家的29位专家参与了本研究。总体而言，第一轮共分发了75条陈述。其中，28%的陈述被接受。根据评论意见，第二轮重新分发了21条陈述，90%被接受。尽管超过90%的专家不同意BD的诊断仅基于临床表现，但BD的非临床表现均未被一致认可为诊断标准的一部分。大家一致认为，任何形式的烟草消费史，不一定局限于当前使用情况，都应作为BD诊断标准的一部分。游走性血栓性静脉炎病史，即使在就诊时不存在，也被接受为BD诊断的线索。大家还一致认为，脚趾或手指变色可纳入BD诊断标准。专家们一致认为，组织学结果可将BD与闭塞性动脉硬化和其他类型的血管炎区分开来。影像学上出现螺旋状侧支血管和灼痛在第一轮达成了一致，但在第二轮未达成一致。关于BD诊断的年龄界限、血脂谱正常和血糖正常的要求，未达成共识。
本研究表明，已发表的各种BD诊断标准存在差异，且在全球范围内的常规临床实践中存在选择性使用的情况。我们建议对所有已发表的BD诊断标准进行重新评估，以实现统一和普遍使用。
