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干货！系统性红斑狼疮3大分类标准怎么选，这篇文章说清楚了

2021-11-15 Shielry MedSci原创

系统性红斑狼疮ACREULAR
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三大系统性红斑狼疮标准怎么选？新的标准一定更好吗？

系统性红斑狼疮（systemic lupus erythema-tosus, SLE）是一种经典的系统性自身免疫病。多系统受累，多变的临床症状，复杂的自身抗体和血清学的表现等因素使得SLE的诊断一直是风湿免疫科医生的一个难题。

从1997年ACR标准的提出到2012年的SLICC诊断标准以及最新的19年EULAR/ACR标准，他们的具体内容和特异性以及敏感性如何呢？

2019年EULAR/ACR

2020年《2020中国系统性红斑狼疮诊疗指南》中推荐用2012年国际狼疮研究临床协作组（SLICC）或2019年EULAR/ACR 制定的SLE分类标准对疑似SLE者进行诊断。

2019年EULAR/ACR指南采用入围与分类双重标准。将ANA阳性作为SLE分类诊断的“入围”标准，ANA阴性则不考虑诊断SLE。因为但在特定条件下，ANA阴性的SLE几乎不存在。

 

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最新的验证队列研究显示，此分类的敏感性为96%，特异性为93%，均为最优。

2012年SLICC标准

2012年的SLICC分类标准其更加强调临床表现和免疫学指标相结合，取消了部分特异性和敏感性不高的临床表现，且更重视系统受累，提高了肾活检在诊断中的重要性。

 

图片

针对新标准的诊断准确性研究显示，此SLE分类标准的敏感性为100%，特异性分别为 75%。显示成人 SLE 中2012 年 SLICC 分类标准相对最优。

1997年EULAR/ACR

1997年美国风湿病学会(ACR)分类标准是世界范围内最广泛应用于分类诊断SLE的标准。

 

图片

其校正之后的特异性和敏感性分别为0.93和0.83，由于敏感性相对较低，容易漏诊，不利于早期诊断。

怎样选择？

目前仅有1997年ACR的SLE分类标准曾在我国SLE人群中进行过验证，结果显示该标准对我国SLE患者具有良好的适用性。新的标准（2012年SLICC、2019年EULAR/ACR）在我国仍然需要更多的数据来验证新SLE标准的适用性。

最新的中国指南也推荐采用新的标准（2012年SLICC/2019 年EULAR/ACR）来进行SLE的诊断。

2012的SLICC标准有虽然有着较高的敏感度，但是特异性较低。

2019年的诊断标准不能诊断 ANA 持续阴性的 SLE，虽然这部分患者并不多见，但也需要探讨其他分类标准的可能性。

2019年的标准对于儿童特异性较低，有研究证实需要将19年的标准≥10分提高到≥13分，则可将其特异度提高到与ACR 1997和SLICC 2012标准相同的水平。

临床医生在选择诊断标准的时候还需要综合考虑，不能只选用最新的标准。必要的时候可以全都要。

参考文献

[1]杨航,刘毅.2019年EULAR/ACR系统性红斑狼疮分类标准解读——先“入围”再“分类”,诊断治疗更精准[J].西部医学,2019,31(11):1643-1645.
[2]宋红梅.儿童风湿病国际相关诊治指南系列解读之一——EULAR-ACR系统性红斑狼疮分类标准解读[J].中国实用儿科杂志,2020,35(04):249-252
[3]Hochberg Mc．Updating the American college of Rheumatology revised crite“a for the classification of systemic 1upus erythemato— sus[J]．Arthritis Rheum，1997(9)，40：1725．
[4]Aringer M，costenbader K，Daikh D，et．2019 European League Against Rheumatism／American C01lege of Rheumatology classification criteria for systemic lupus erythematosus[J]． Ann Rheum Dis，2019，78(9)：1151—1159．
[5]Petfi M，0rbai AM，Alarcon Gs，nf．De“vation and validation of the Systemic Lupus International Collaborating Clinics classifi— cation criteria for systemic lupus erythematosus[J]．Arth“tis Rheum，2012，64(8)：2677—2686．
[6].2020中国系统性红斑狼疮诊疗指南[J].中华内科杂志,2020(03):172-173-174-175-176-177-178-179-180-181-182-183-184-185.

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    2023-06-25 ms4000000304602592 来自贵州省

    学习了

    0

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    2022-07-17 qingrejiedu

    #系统性#

    0

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    2021-11-17 sunrural_42825357

    #狼疮#

    0

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    2021-11-17 yytms

    #分类标准#

    0

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    2021-11-17 zhouqu_8

    #红斑#

    0

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    2021-11-15 含子

    学习了

    0

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