Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Int J Rheum Dis. 2024 May;27(5):e15175. doi: 10.1111/1756-185X.15175.
To analyze antiphospholipid antibody (aPL)-positive patients using the 2023 American College of Rheumatology/The European Alliance of Associations for Rheumatology (ACR/EULAR) antiphospholipid syndrome (APS) classification criteria and compare the revised Sapporo criteria and the 2023 ACR/EULAR criteria and evaluate whether the 2023 ACR/EULAR criteria provide added value over the revised Sapporo criteria.
In this descriptive study, 94 aPL-positive patients (with or without APS diagnosis) were identified from two hospital-based registries (Gazi and Hacettepe University). Patients were classified into four groups to compare both criteria sets. These four groups are as follows: (1) patients classified with only the revised Sapporo criteria; (2) patients classified with only the 2023 ACR/EULAR APS criteria; (3) patients classified with both two criteria sets; and (4) patients classified with neither two criteria set.
Of the 94 patients, 11 were classified with only the revised Sapporo criteria; one with only the 2023 ACR/EULAR APS criteria; 52 with both criteria sets; and 30 with neither set of criteria. For these 94 patients, the operating characteristics of the 2023 ACR/EULAR APS criteria, using the revised Sapporo criteria as the gold standard, the 2023 ACR/EULAR APS entry criteria demonstrated 100% sensitivity, and the 2023 ACR/EULAR APS classification criteria demonstrated 98% specificity and 82.5% sensitivity.
The study emphasizes the importance of recognizing differences in clinical manifestations, such as early pregnancy loss without severe preeclampsia (PEC) and/or severe placental insufficiency (PI) and calls for a nuanced discussion on anticardiolipin (aCL) and anti-beta 2-glycoprotein-I (anti-β2GPI) immunoglobulin G (IgG) cutoff values.
使用 2023 年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）抗磷脂综合征（APS）分类标准分析抗磷脂抗体（aPL）阳性患者，并比较修订后的 Sapporo 标准和 2023 年 ACR/EULAR 标准，评估 2023 年 ACR/EULAR 标准是否比修订后的 Sapporo 标准更具价值。
在这项描述性研究中，从两个医院登记处（加济大学和哈塞特佩大学）确定了 94 名 aPL 阳性患者（有或没有 APS 诊断）。将患者分为四组以比较两套标准。这四组分别是：（1）仅符合修订后的 Sapporo 标准的患者；（2）仅符合 2023 年 ACR/EULAR APS 标准的患者；（3）同时符合两套标准的患者；（4）不符合两套标准的患者。
在 94 名患者中，11 名仅符合修订后的 Sapporo 标准，1 名仅符合 2023 年 ACR/EULAR APS 标准，52 名同时符合两套标准，30 名不符合两套标准。对于这 94 名患者，使用修订后的 Sapporo 标准作为金标准，2023 年 ACR/EULAR APS 标准的操作特征为 100%的敏感性，2023 年 ACR/EULAR APS 分类标准的特异性为 98%，敏感性为 82.5%。
该研究强调了认识临床表现差异的重要性，如无严重子痫前期（PEC）和/或严重胎盘功能不全（PI）的早期妊娠丢失，并呼吁对抗心磷脂（aCL）和抗β2-糖蛋白 I（抗-β2GPI）免疫球蛋白 G（IgG）临界值进行细致讨论。
