实用医学杂志 ›› 2022, Vol. 38 ›› Issue (1): 96-100.doi: 10.3969/j.issn.1006⁃5725.2022.01.018

• 医学检查与临床诊断 • 上一篇    下一篇

EULAR/ACR⁃2019、SLICC⁃2012、ACR⁃1997三种系统性红斑狼疮分类标准的比较

林超群1 王海洪1 沙璐莹1 王妍清1 黄红莲1 申婕1 宋居艳1 申小平2   

  1. 1 贵阳市第一人民医院皮肤科（贵阳 550000）；2 贵州医科大学附属医院皮肤科（贵阳550000）

  • 出版日期:2022-01-10 发布日期:2022-01-10

Classification criteria of EULAR/ACR ⁃ 2019，SLICC ⁃2012，and ACR ⁃1997：A comparative study 

LIN Chaoqun*，WANG Haihong，SHA Luying，WANG Yanqing，HUANG Honglian，SHEN Jie，SONG Juyan，SHEN Xiaoping.   

  1. Department of Dermatology，Guiyang First People′s Hospital，Guiyang 550000，China
  • Online:2022-01-10 Published:2022-01-10

摘要：

目的 基于临床病例比较 2019 年欧洲抗风湿病联盟/美国风湿病学会（European League Against Rheumatism/American College of Rheumatology，EULAR/ACR）、2012 年系统性红斑狼疮国际合作临床组织（Systemic Lupus International Collaborating Clinics，SLICC）及 1997 年美国风湿病学会（American College of Rheumatology，ACR）系统性红斑狼疮（systemic lupus erythematoses，SLE）分类标准间的差异并评估不同 分类标准的诊断价值。方法 收集 2014 年 1 月至 2019 年 12 月于贵州医科大学附属医院确诊为 SLE 病例 73 例，以其他结缔组织病 82 例为对照，统计患者各项临床指标及免疫学指标的数据，比较不同分类标准间灵敏度、特异度及 ROC 曲线下面积的差异。结果 EULAR/ACR⁃2019、SLICC⁃2012 及 ACR⁃1997 灵敏度 及特异度分别为 95.89%、98.63%、73.97%及 92.68%、84.15%、98.78%，灵敏度及特异度在三种不同分类标准间存在显著差异，其中 ACR⁃1997 灵敏度最低，SLICC⁃2012 特异度最低（P < 0.001）。EULAR/ACR⁃2019、 SLICC⁃2012、ACR⁃1997之间漏诊率、误诊率相比差异有统计学意义，其中ACR ⁃1997漏诊率最高，但误诊率最低（P < 0.05）。EULAR/ACR⁃2019、SLICC⁃2012、ACR⁃1997 的 ROC 曲线下面积（AUC）分别为 0.943、0.914、 0.864。EULAR/ACR⁃2019 与 ACR⁃1997 间 AUC 差异有统计学意义（P = 0.0044），但 SLICC⁃2012 与 EULAR/ ACR⁃2019 及 ACR⁃1997 之间 AUC 的差异无统计学意义（P > 0.005）。结论 EULAR/ACR⁃2019 的 SLE 诊断 价值优于 ACR⁃1997，但 SLICC⁃2012 与 EULAR/ACR⁃2019、ACR⁃1997 相比无明显优势。将 EULAR/ACR⁃ 2019和SLICC⁃2012分类标准与临床诊断相结合可能更有助于SLE 的早期诊断，并指导治疗。

关键词: 系统性红斑狼疮, 分类标准, 比较研究, 早期诊断

Abstract:

Objective To compare the classification criteria for systemic lupus erythematosus（SLE）by the European League Against Rheumatism/American College of Rheumatology ⁃ 2019（EULAR/ACR ⁃2019），the International Cooperative Clinical Organization ⁃2012（SLICC ⁃2012）and the American College of Rheumatology ⁃ 1997（ACR⁃1997）and evaluate the diagnostic values of the three classification criteria in combination with practical diagnosis of clinical cases. Methods A total of 73 cases diagnosed with SLE in the Affiliated Hospital of Guizhou Medical University from January 2014 to December 2019 were enrolled as the SLE goup，and another group of 82 cases diagnosed with other connective histdiseases were assigned as the control group. The data from various clinical indica⁃ tors and immunological indicators were collected and analyzed in terms of the differences in sensitivity，specificity and area under ROC curve between the three SLE classification criteria. Results There were significant differences in the sensitivity and specificity between EULAR/ACR-2019,SLICC-2012 and ACR-1997,respectively(95.89% vs. 98.63% vs. 73.97%；92.68% vs. 84.15% vs. 98.78%). The sensitivity of ACR⁃1997 was the lowest,and the speci⁃ ficity of SLICC⁃2012 was the lowest(P<0.001).There were significant differences in missed diagnosis rate and misdiagnosis rate between EULAR/ACR⁃2019，SLICC⁃2012 and ACR⁃1997，ACR⁃1997 having the highest missed diagnosis rate and the lowest misdiagnosis rate（P < 0.05）. The areas under the ROC curve（AUC）of EULAR/ACR⁃ 2019，SLICC ⁃2012，and ACR ⁃1997 were 0.943，0.914 and 0.864，respectively，with statistically significant dif⁃ fernces between them（P = 0.0044），but the AUC was not significant between SLICC⁃2012 and EULAR/ACR⁃2019， ACR⁃1997（P > 0.005）. Conclusion The SLE diagnostic value of EULAR/ACR⁃2019 is better than ACR⁃1997 and SLICC⁃2012 has no significant advantage over EULAR/ACR⁃2019 and ACR⁃1997. The combination of EULAR/ACR⁃ 19 with SLICC⁃12 may be more advantegeous in the early diagnosis of SLE and the direction for its treatment.

Key words:

systemic lupus erythematosus, classification criteria, comparative study, early diagnosis

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