Assessment of the 2023 ACR/EULAR antiphospholipid syndrome classification criteria in a Chinese cohort: Impact on clinical practice

IF 7.9 1区医学 Q1 IMMUNOLOGY

Journal of autoimmunity Pub Date : 2024-05-14 DOI:10.1016/j.jaut.2024.103237

Yaqing Yang , Haiyue Jiang , Zihan Tang , Haoyu Pan, Honglei Liu, Xiaobing Cheng, Yutong Su, Junna Ye, Qiongyi Hu, Jianfen Meng, Huihui Chi, Zhuochao Zhou, Jinchao Jia, Chengde Yang, Hui Shi , Jialin Teng , Tingting Liu

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引用次数: 0

Abstract

Objectives

To evaluate the effectiveness of the 2023 ACR/EULAR criteria for antiphospholipid syndrome (APS) in a Chinese cohort, and compare them with the Sapporo and revised Sapporo criteria.

Methods

A cohort comprising 436 patients diagnosed with APS and 514 control subjects was enrolled, including 83 with seronegative APS and 86 classified as antiphospholipid antibody (aPL) carriers. We assessed IgG and IgM anticardiolipin antibodies (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies using ELISA, along with a systematic collection of lupus anticoagulant data. Subsequently, we compared the sensitivity and specificity across the three classification criteria.

Results

The 2023 ACR/EULAR criteria exhibited improved specificity at 98 %, surpassing the revised Sapporo (90 %) and original Sapporo (91 %) criteria. However, this came with decreased sensitivity at 82 %, in contrast to higher sensitivities in the revised Sapporo (98 %) and Sapporo (91 %) criteria. Examining individual components sheds light on the scoring system's rationale within the new criteria. The inclusion of microvascular thrombosis, cardiac valve disease, and thrombocytopenia improved the identification of nine patients previously classified as “probable APS”. Insufficient scoring in 78 previously diagnosed APS individuals was linked to traditional risk factor evaluations for thrombotic events, the emphasis on determining whether obstetric events are linked to severe preeclampsia (PEC) or placental insufficiency (PI), and the lower scores assigned to IgM aCL and/or aβ2GPI antibody. Seronegative APS remained a challenge, as non-criteria aPL and other methods were not included.

Conclusions

The new criteria presented notable advancements in specificity. This study provides detailed insights into the strengths and possible challenges of the 2023 ACR/EULAR criteria, enhancing our understanding of their impact on clinical practice.

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在中国队列中评估 2023 ACR/EULAR 抗磷脂综合征分类标准：对临床实践的影响。

目的评估2023年ACR/EULAR抗磷脂综合征（APS）标准在中国人群中的有效性，并将其与札幌标准和修订版札幌标准进行比较：方法：我们招募了由 436 名确诊为 APS 的患者和 514 名对照受试者组成的队列，其中包括 83 名血清阴性 APS 患者和 86 名抗磷脂抗体（aPL）携带者。我们使用 ELISA 方法评估了 IgG 和 IgM 抗心磷脂抗体（aCL）和抗β2-糖蛋白 I（aβ2GPI）抗体，并系统收集了狼疮抗凝数据。随后，我们比较了三种分类标准的敏感性和特异性：结果：ACR/EULAR 2023 标准的特异性提高到 98%，超过了修订版札幌标准（90%）和原版札幌标准（91%）。然而，与修订版札幌标准（98%）和札幌标准（91%）的较高敏感性相比，该标准的敏感性有所下降，仅为 82%。在新标准中，对各个组成部分的研究揭示了评分系统的基本原理。纳入微血管血栓形成、心脏瓣膜疾病和血小板减少症后，以前被归类为 "可能的 APS "的九名患者的识别率有所提高。78 名先前被诊断为 APS 的患者得分不足，这与血栓事件的传统风险因素评估、强调产科事件是否与重度子痫前期（PEC）或胎盘功能不全（PI）有关以及 IgM aCL 和/或 aβ2GPI 抗体得分较低有关。血清阴性 APS 仍是一项挑战，因为非标准 aPL 和其他方法并未包括在内：新标准在特异性方面取得了显著进步。本研究详细介绍了 2023 年 ACR/EULAR 标准的优势和可能面临的挑战，加深了我们对其对临床实践影响的理解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of autoimmunity 医学-免疫学

CiteScore

27.90

自引率

1.60%

发文量

117

审稿时长

17 days

期刊介绍： The Journal of Autoimmunity serves as the primary publication for research on various facets of autoimmunity. These include topics such as the mechanism of self-recognition, regulation of autoimmune responses, experimental autoimmune diseases, diagnostic tests for autoantibodies, as well as the epidemiology, pathophysiology, and treatment of autoimmune diseases. While the journal covers a wide range of subjects, it emphasizes papers exploring the genetic, molecular biology, and cellular aspects of the field. The Journal of Translational Autoimmunity, on the other hand, is a subsidiary journal of the Journal of Autoimmunity. It focuses specifically on translating scientific discoveries in autoimmunity into clinical applications and practical solutions. By highlighting research that bridges the gap between basic science and clinical practice, the Journal of Translational Autoimmunity aims to advance the understanding and treatment of autoimmune diseases.