2009 SLICC修改的ACR系统性红斑狼疮分类标准SLICC Revision of the ACR Classification Criteria for SLEPetri, Michelle, Systemic Lupus International Collaborating Clinic (SLICC)参考网址：1.2.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 Criteria1. Acute or subacute cutaneous lupus2. Chronic cutaneous lupus3. Oral/Nasal ulcers4. Nonscarring alopecia5. Inflammatory synovitis with physician-observed swelling of two or more joints OR tender joints with morning stiffness6. Serositis7. Renal: Urine protein/creatinine (or 24 hr urine protein) representing at least 500 mg of protein/24 hr or red blood cell casts8. Neurologic: seizures, psychosis, mononeuritis multiplex, myelitis, peripheral or cranial neuropathy, cerebritis (acute confusional state)9. Hemolytic anemia10. Leukopenia (<4000/mm3 at least once)ORLymphopenia (<1000/mm3 at least once)11. Thrombocytopenia (<100,000/mm3) at least onceImmunologic Criteria1. ANA above laboratory reference range2. Anti-dsDNA above laboratory reference range (except ELISA: twice above laboratory reference range)3. Anti-Sm4. Antiphospholipid antibodylupus anticoagulantfalse-positive test for syphilisanticardiolipin–at least twice normal or medium-high titeranti-b2 glycoprotein 15. Low complementlow C3low C4low CH506. Direct Coombs test in absence of hemolytic anemiaWhen 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====================================================== ======================中文版====================================================== ==================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①狼疮抗凝物阳性②梅毒血清学试验假阳性③抗心磷脂抗体-至少两倍正常值或中高滴度④抗b2 糖蛋白1阳性5.低补体①低C3②低C4③低CH506.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)其实，就是因为看到之前网上的很多翻译过来的标准内容比较含糊，我才贴上英文原文和自己的翻译。
我觉得要获得正确的认识还是最好看原文。
1.临床标准第四条Nonscarring alopecia：alopecia译为“脱发”为好，“秃发”是什么意思啊？有点莫名奇妙，中文里面说“秃头”，哪有说“秃发”的呢。
2.关节炎的问题：这个新标准中的关节炎定义有两个，一个就是医生观察到的两个或两个以上的关节肿胀，另一个是伴晨僵的触痛。
符合任何一个都可以算关节炎了。
不是说关节痛就不算的问题。
有关节触痛如果同时伴关节晨僵也算炎症性滑膜炎的。
3.几种类型的皮肤狼疮的问题：有一段话，可以参考，借鉴下：50年代采用的Bundick和Ellis分类法为：①局限性盘状红斑狼疮;②播散性红斑狼疮，其下又分急性、亚急性和慢性播散性红斑狼疮，(播散性盘状红斑狼疮)。
随着对本病的研究日趋广泛和深入，其后出现了不少分类方法。
北村根据皮损性质不同将本病分成：①不全型(顿挫型);②慢性盘状干燥型;③慢性盘状渗出液;④色素增生型;⑤慢性播散型;⑥急性播散型。
Martin将本病分成：①隐性红斑狼疮;②有特异性皮损而无系统性症状者;③有特异性皮损亦有系统性症状者;④有系统性症状而无特异性皮损者。
Gilliam将患者皮损不论其有否皮损外病变分成：①慢性皮肤红斑狼疮(CCLE)，又可分为局限性盘状红斑狼疮、泛发性盘状红斑狼疮，肥厚性盘状红斑狼疮、深部红斑狼疮;②亚急性皮肤型红斑狼疮(SCLE);③急性红斑狼疮，可分为面(颧)部红斑，面、头皮、颈、上胸、肩臂伸面和手背红斑，大疱性或中毒性表皮松解样损害。