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检查单解读SLICC Revision of the ACR Classification Criteria for SLE
Petri, Michelle, Systemic Lupus International Collaborating Clinic (SLICC)
参考网址：1. http://acr.confex.com/acr/2009/webprogram/Paper13266.html 中山大学附属第六医院风湿免疫科黄建林
2. http://www.blackwellpublishing.com/acrmeeting/abstract.asp?MeetingID=761&id=80525
Purpose:
The ACR Classification Criteria for SLE date from 1982 with a 1997 revision that was not validated. Because of new knowledge of autoantibodies, neuropsychiatric lupus, the importance of low complement and the need for lupus nephritis to be a "stand alone" criterion, the SLICC group undertook a revision.
Method:
An initial set of relevant variables was determined. Real patient scenarios (n=716) of SLE and non-SLE controls were submitted by SLICC centers. A consensus diagnosis was arrived at for each scenario. The consensus diagnoses were used to identify the variables that were most predictive of SLE. Recursive partitioning was employed to derive a classification rule based on multiple candidates predictor variables. This preliminary classification rule was discussed at three SLICC meetings, independently validated by a SLICC steering comittee and further refined.
Results:
Classify a patient as having SLE if: The patient has biopsy-proven lupus nephritis with ANA or anti-dsDNA OR the patient satisfies four of the criteria, including at least one clinical and one immunologic criterion.
Clinical Criteria
1. Acute or subacute cutaneous lupus
2. Chronic cutaneous lupus
3. Oral/Nasal ulcers
4. Nonscarring alopecia
5. Inflammatory synovitis with physician-observed swelling of two or more joints OR tender joints with morning stiffness
6. Serositis
7. Renal: Urine protein/creatinine (or 24 hr urine protein) representing at least 500 mg of protein/24 hr or red blood cell casts
8. Neurologic: seizures, psychosis, mononeuritis multiplex, myelitis, peripheral or cranial neuropathy, cerebritis (acute confusional state)
9. Hemolytic anemia
10. Leukopenia (<4000/mm3 at least once)
OR
Lymphopenia (<1000/mm3 at least once)
11. Thrombocytopenia (<100,000/mm3) at least once
Immunologic Criteria
1. ANA above laboratory reference range
2. Anti-dsDNA above laboratory reference range (except ELISA: twice above laboratory reference range)
3. Anti-Sm
4. Antiphospholipid antibody
lupus anticoagulant
false-positive test for syphilis
anticardiolipin–at least twice normal or medium-high titer
anti-b2 glycoprotein 1
5. Low complement
low C3
low C4
low CH50
6. Direct Coombs test in absence of hemolytic anemia
When applied to our patient scenarios, this classification rule had better sensitivity than the ACR 11 (94% vs. 86%), and roughly equal specificity (92% vs. 93%), and resulted in significantly fewer misclassifications (p=.0082).
Conclusion:
The SLICC SLE classification criteria address the major deficiencies of the ACR. Currently, ongoing validation will determine if they perform better than the ACR criteria.
To cite this abstract, please use the following information:
Petri, Michelle, Systemic Lupus International Collaborating Clinic (SLICC), ; SLICC Revision of the ACR Classification Criteria for SLE [abstract]. Arthritis Rheum 2009;60 Suppl 10 :895
DOI: 10.1002/art.25975
2009 SLICC修改的ACR系统性 红斑狼疮 分类标准
临床标准
1.急性或亚急性皮肤狼疮
2.慢性皮肤狼疮
3.口腔/鼻溃疡
4.不留瘢痕的脱发
5.炎症性滑膜炎，内科医生观察到的两个或两个以上关节肿胀或伴晨僵的关节触痛
6.浆膜炎
7.肾脏：用尿蛋白/肌酐比值（或24小时尿蛋白）算，至少500mg蛋白/24小时，或有红细胞管型
8.神经系统：癜痫发作，精神病，多发性单神经炎，脊髓炎，外周或颅神经病变， 脑炎 （急性精神混乱状态
9.溶血性 贫血
10.白细胞减少（至少一次< 4000/mm3）或淋巴细胞减少（至少一次< 1000/mm3）
11.至少一次血小板减少(<100,000/mm3)
免疫学标准
1.ANA高于实验室参考值范围
2.抗ds-DNA高于实验室参考值范围（ELISA法另外，用此法检测，需两次高于实验室参考值范围）
3.抗sm阳性
4.抗磷脂抗体
狼疮抗凝物阳性
梅毒血清学试验假阳性
抗心磷脂抗体-至少两倍正常值或中高滴度
抗b2 糖蛋白1阳性
5.低补体
低C3
低C4
低CH50
6.在无溶血性 贫血 者，直接coombs试验阳性
患者如果满足下列条件至少一条，则归类于系统性 红斑狼疮 ：1.有活检证实的狼疮肾炎，伴有ANA阳性或抗ds-DNA阳性；2.患者满足分类标准中的4条，其中包括至少一条临床标准和一条免疫学标准。
在入选的患者中应用此标准，较ACR标准有更好的敏感性(94% vs. 86%)，并与ACR标准有大致相同的特异性(92% vs. 93%)，同时明显减少误分类(p=0.0082)。
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