目的:探讨单独的实验室项目在系统性红斑狼疮(SLE)分类中的表现。
方法:我们的队列包括352和385(对照)患有和不患有SLE的患者。这项研究评估了美国风湿病学会(ACR)-1997,系统性狼疮国际合作诊所(SLICC)-2012,欧洲抗风湿病联盟(EULAR)/ACR-2019和系统性红斑狼疮风险概率指数(SLERPI)仅使用实验室项目,包括血液和尿液检查结果.
结果:实验室项目/总项目的中位数为66.7%,75.0%,60.4%,在ACR-1997、SLICC-2012、EULAR/ACR-2019和SLERPI中占77.4%,分别。在单独包括实验室项目之后,ACR-1997,SLICC-2012,EULAR/ACR-2019和SLERPI的敏感性为31.3%(95%置信区间[CI]:26.4%-36.4%),79.8%(95%CI:75.3%-83.9%),75.9%(95%CI:71.0%-80.2%),和85.2%(95%CI:81.1%-88.8%),分别。我们引用了SLERPI并删除了额外的限制,即,SLICC-2012标准只需要满足至少四个项目(mSLICC-2012)和EULAR/ACR-2019标准需要≥10分(mEULAR/ACR-2019)才有资格获得SLE分类。mSLICC-2012和mEULAR/ACR-2019标准,包括单独的实验室项目,新发现的13和25名患者,分别。仅基于实验室项目,mSLICC-2012,mEULAR/ACR-2019和SLERPI的联合检测发现348例患者的敏感性改善为90.6%(95%CI:87.1%-93.5%).患者,他们是根据mEULAR/ACR-2019标准分类的,都符合其他标准。
结论:单独纳入实验室项目在临床上是可行的,有助于鉴别SLE。SLERPI和SLICC-2012,仅使用实验室项目,与EULAR/ACR-2019相比,更值得在临床推广。要点•实验室项目在SLE分类标准中起着至关重要的作用,仅纳入实验室项目在临床上是可行的,以帮助鉴定SLE。•SLERPI和SLICC-2012,仅使用实验室项目,与EULAR/ACR-2019相比,在临床上更值得推广,两者联合使用可进一步提高敏感性。•评估实验室指标的相对简单性可以帮助非风湿病学家和缺乏经验的风湿病学家更快地识别SLE,从而降低患者延迟诊断的风险。
OBJECTIVE: To explore the performance of laboratory items alone in systemic lupus erythematosus (SLE) classification.
METHODS: Our cohort consisted of 352 and 385 (control) patients with and without SLE. This
study evaluated the performance of the American College of Rheumatology (ACR)-1997, Systemic Lupus International Collaborating Clinics (SLICC)-2012, European League Against Rheumatism (EULAR)/ACR-2019, and Systemic Lupus Erythematosus Risk Probability Index (SLERPI) using laboratory items alone, including blood and urine test results.
RESULTS: The median ratio of laboratory items/total items was 66.7%, 75.0%, 60.4%, and 77.4% in ACR-1997, SLICC-2012, EULAR/ACR-2019, and SLERPI, respectively. After including laboratory items alone, the sensitivity of ACR-1997, SLICC-2012, EULAR/ACR-2019, and SLERPI was 31.3% (95% confidence interval [CI]: 26.4%-36.4%), 79.8% (95% CI: 75.3%-83.9%), 75.9% (95% CI: 71.0%-80.2%), and 85.2% (95% CI: 81.1%-88.8%), respectively. We referenced the SLERPI and removed the additional restrictions, i.e., SLICC-2012 criteria only needs to fulfill at least four items (mSLICC-2012) and EULAR/ACR-2019 criteria needs to have ≥ 10 points (mEULAR/ACR-2019) to qualify for SLE classification. The mSLICC-2012 and mEULAR/ACR-2019 criteria, including laboratory items alone, newly identified 13 and 25 patients, respectively. Based on laboratory items alone, the combination of mSLICC-2012, mEULAR/ACR-2019, and SLERPI identified 348 patients with an improved sensitivity of 90.6% (95% CI: 87.1%-93.5%). Patients, who were classified according to the mEULAR/ACR-2019 criteria, all met the other criteria.
CONCLUSIONS: Incorporating laboratory items alone was clinically feasible to help identify SLE. SLERPI and SLICC-2012, using laboratory items alone, were more worthwhile to promote in the clinic compared with EULAR/ACR-2019. Key Points • Laboratory items play a crucial role in the SLE classification criteria, and incorporating laboratory items alone was clinically feasible to help in the identification of SLE. • The SLERPI and SLICC-2012, using laboratory items alone, were more worthwhile to promote in the clinic compared with EULAR/ACR-2019, and the combination of the two could further improve the sensitivity. • The relative simplicity of evaluating laboratory indices may help nonrheumatologists and inexperienced
rheumatologists to identify SLE more quickly, thereby reducing the risk of delayed diagnosis in patients.