<br>JSLE 中 SLE 的 ACR/EULAR-2019 分类标准的敏感性和特异性有限？——来自英国 JSLE 队列研究的观察结果,Rheumatology

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JSLE 中 SLE 的 ACR/EULAR-2019 分类标准的敏感性和特异性有限？——来自英国 JSLE 队列研究的观察结果
Rheumatology ( IF 4.7 ) Pub Date : 2021-03-01 , DOI: 10.1093/rheumatology/keab210
Eve M D Smith _{1,

2} , Sajida Rasul ₃ , Coziana Ciurtin ₄ , Eslam Al-Abadi ₅ , Kate Armon ₆ , Kathryn Bailey ₇ , Mary Brennan ₈ , Janet Gardner-Medwin ₉ , Kirsty Haslam ₁₀ , Daniel P Hawley ₁₁ , Steven Lane ₂ , Alice Leahy ₁₂ , Valentina Leone ₁₃ , Gulshan Malik ₁₄ , Devesh Mewar ₁₅ , Robert Moots ₁₆ , Clarissa Pilkington ₁₇ , Athimalaipet V Ramanan ₁₈ , Satyapal Rangaraj ₁₉ , Annie Ratcliffe ₂₀ , Phil Riley ₃ , Ethan Sen ₂₁ , Arani Sridhar ₂₂ , Nick Wilkinson ₂₃ , Michael W Beresford _{1,

2} , Liza J McCann _{1,

2} , Christian M Hedrich _{1,

2}

Affiliation

Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool.
Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool.
Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester.
Department of Rheumatology, Centre for Adolescent Rheumatology, University College London, London.
Department of Rheumatology, Birmingham Children's Hospital, Birmingham.
Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge.
Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford.
Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh.
Department of Child Health, University of Glasgow, Glasgow.
Department of Paediatrics, Bradford Royal Infirmary, Bradford.
Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield.
Department of Paediatric Rheumatology, Southampton General Hospital, Southampton.
Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds.
Paediatric Rheumatology, Royal Aberdeen Children's Hospital, Aberdeen.
Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool.
Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk.
Department of Paediatric Rheumatology, Great Ormond Street Hospital, London.
University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol.
Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham.
Department of Paediatrics, Musgrove Park Hospital, Taunton.
Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne.
Leicester Children's Hospital, University Hospitals of Leicester NHS trust, Leicester.
Department of Paediatric Rheumatology, Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK.

目标本研究旨在测试 JSLE 中新 ACR 和 EULAR 标准的性能，其中包括 ANA 阳性作为准入标准。方法使用英国 JSLE 队列研究 (n = 482) 中儿童和青少年 (CYP) 的数据，将 ACR/EULAR-2019 标准的表现与系统性狼疮国际合作诊所 (SLICC-2012) 进行比较，其中 ACR- 1997 年标准用作参考标准。使用未选择的 ANA CYP 阳性队列 (n = 129) 来计算标准的阳性/阴性预测值。结果在第一次和最后一次就诊时，满足不同分类标准的患者数量差异显着 (P < 0.001)。首次和末次就诊时，SLICC-2012 标准的敏感性高于 ACR/EULAR-2019 标准（首次就诊为 98% vs 94%，末次就诊为 98% vs 96%；P < 0.001），当考虑所有可用的 CYP 时。与 SLICC-2012 标准相比，ACR/EULAR-2019 标准更加具体（首次就诊为 77% vs 67%，上次就诊为 81% vs 71%；P < 0.001）。分类标准之间的显着差异主要是由于不同年龄阶段 ANA 阳性率的差异造成的。在未选择的 ANA 阳性 CYP 队列中，ACR/EULAR-2019 标准产生了最高的假阳性分类（6/129，5%）。结论在CYP中，ACR/EULAR-2019标准并不优于SLICC-2012或ACR-1997标准。如果分类标准旨在包括 CYP 和成年人群，则应将儿科风湿病专家纳入共识和评估过程中，因为看似微小的变化可能会显着影响结果。

"点击查看英文标题和摘要"

Limited sensitivity and specificity of the ACR/EULAR-2019 classification criteria for SLE in JSLE?—observations from the UK JSLE Cohort Study

Objectives This study aimed to test the performance of the new ACR and EULAR criteria, that include ANA positivity as entry criterion, in JSLE. Methods Performance of the ACR/EULAR-2019 criteria were compared with Systemic Lupus International Collaborating Clinics (SLICC-2012), using data from children and young people (CYP) in the UK JSLE Cohort Study (n = 482), with the ACR-1997 criteria used as reference standard. An unselected cohort of CYP positive for ANA (n = 129) was used to calculate positive/negative predictive values of the criteria. Results At both first and last visits, the number of patients fulfilling the different classification criteria varied significantly (P < 0.001). The sensitivity of the SLICC-2012 criteria was higher when compared with that of the ACR/EULAR-2019 criteria at first and last visits (98% vs 94% for first visit, and 98% vs 96% for last visit; P < 0.001), when all available CYP were considered. The ACR/EULAR-2019 criteria were more specific when compared with the SLICC-2012 criteria (77% vs 67% for first visit, and 81% vs 71% for last visit; P < 0.001). Significant differences between the classification criteria were mainly caused by the variation in ANA positivity across ages. In the unselected cohort of ANA-positive CYP, the ACR/EULAR-2019 criteria produced the highest false-positive classification (6/129, 5%). Conclusion In CYP, the ACR/EULAR-2019 criteria are not superior to those of the SLICC-2012 or ACR-1997 criteria. If classification criteria are designed to include CYP and adult populations, paediatric rheumatologists should be included in the consensus and evaluation process, as seemingly minor changes can significantly affect outcomes.

更新日期：2021-03-01

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