Lopez-Gomez Marta, Moya-Alvarado Patricia, Park Hye Sang, Martín Mar Concepción, Calleja Sara, Codes-Mendez Helena, Magallares Berta, Castellví Iván, Barros-Membrilla Antonio J, Laiz Ana, Diaz-Torné César, Sainz Luis, Bernárdez Julia, Martínez-Martinez Laura, Corominas Hèctor
Rheumatology Department, Hospital Universitario Araba, 01009 Vitoria, Spain.
Instituto de Investigación Biomédica BIORABA, Hospital Universitario Araba, 01009 Vitoria, Spain.
Diagnostics (Basel). 2024 Nov 17;14(22):2583. doi: 10.3390/diagnostics14222583.
We conducted a comprehensive comparative analysis of the Okazaki, Umehara, and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for diagnosing immunoglobulin G4-related disease (IgG4-RD).
A retrospective study was conducted in a single tertiary hospital, using expert clinical judgment as the gold standard. We compared the diagnostic accuracy of the Okazaki, Umehara, and ACR/EULAR criteria in a cohort of 41 patients with suspected IgG4-RD. We assessed sensitivity, specificity, and positive and negative predictive values for each criterion, and conducted a separate analysis based on four IgG4-RD subtypes.
A total of 30 patients were confirmed to have IgG4-RD and 11 were identified as mimickers. The Umehara criteria demonstrated the highest sensitivity (83.33%), followed by the ACR/EULAR 2019 (66.67%) and Okazaki (60.0%) criteria. All three criteria exhibited 100% specificity, with overall diagnostic accuracy ranging from 70% to 88%. The areas under the curve (AUC) were 0.917 (Umehara), 0.800 (Okazaki), and 0.833 (ACR/EULAR 2019), indicating significant diagnostic effectiveness ( < 0.000). Subtype analysis revealed that the Umehara and ACR/EULAR 2019 criteria were more effective in diagnosing pancreato-hepato-biliary involvement (subtype 1), while the Okazaki and ACR/EULAR 2019 criteria were more effective in diagnosing retroperitoneal fibrosis and/or aortitis (subtype 2).
Our study provides valuable insights into the diagnostic performance of the Okazaki, Umehara, and ACR/EULAR criteria for a cohort of patients with suspected IgG4-RD. The Umehara criterion demonstrated the highest sensitivity, suggesting its potential utility for screening purposes, while all three criteria showed consistent specificity.
我们对用于诊断免疫球蛋白G4相关疾病（IgG4-RD）的冈崎标准、梅原标准以及美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）分类标准进行了全面的比较分析。
在一家三级医院进行了一项回顾性研究，将专家临床判断作为金标准。我们比较了冈崎标准、梅原标准和ACR/EULAR标准在41例疑似IgG4-RD患者队列中的诊断准确性。我们评估了每个标准的敏感性、特异性以及阳性和阴性预测值，并基于四种IgG4-RD亚型进行了单独分析。
共有30例患者确诊为IgG4-RD，11例被鉴定为疑似病例。梅原标准显示出最高的敏感性（83.33%），其次是ACR/EULAR 2019标准（66.67%）和冈崎标准（60.0%）。所有三个标准的特异性均为100%，总体诊断准确性在70%至88%之间。曲线下面积（AUC）分别为0.917（梅原标准）、0.800（冈崎标准）和0.833（ACR/EULAR 2019标准），表明具有显著的诊断有效性（<0.000）。亚型分析显示，梅原标准和ACR/EULAR 2019标准在诊断胰腺-肝胆受累（亚型1）方面更有效，而冈崎标准和ACR/EULAR 2019标准在诊断腹膜后纤维化和/或主动脉炎（亚型2）方面更有效。
我们的研究为冈崎标准、梅原标准和ACR/EULAR标准在疑似IgG4-RD患者队列中的诊断性能提供了有价值的见解。梅原标准显示出最高的敏感性，表明其在筛查方面的潜在效用，而所有三个标准的特异性一致。
