新分类标准对结节性多动脉炎诊断影响的研究初探

随着对抗中性粒细胞胞质抗体(ANCA)相关性血管炎的认识及乙型病毒性肝炎疫苗的广泛接种,结节性多动脉炎(PAN)的诊断发生了很大变化。本研究结合2012年Chapel Hill共识会议(CHCC)对PAN的定义和2007年欧洲药品管理局(EMA)对中小血管炎分类法则,对2002年1月至2018年12月在北京协和医院住院并符合1990年美国风湿病学会(ACR)PAN分类标准的113例PAN患者重新分类,以了解新分类标准对PAN诊断的影响。113例PAN患者中皮肤型PAN者9例,经典型PAN者80例,HBV相关型PAN者24例。经过2012年CHCC PAN定义和2007年EMA中小血管炎分类法则,共有26例(23%)PAN患者被重新归类为其他系统性血管炎,7例归类为显微镜下多血管炎(MPA),19例归类为未分类血管炎。随着PAN分类法则的更新,PAN的诊断率有所下降,我国仍有一部分PAN患者,需引起重视。

Use of new diagnostic criteria for reclassification of polyarteritis nodosa

With the recognition of antineutrophil cytoplasmic antibodies(ANCA)-related vasculitis and widespread vaccination against viral hepatitis B,the prevalence of polyarteritis nodosa(PAN)varied considerably.In our study,patients diagnosed as polyarteritis nodasa(PAN)based on the 1990 American College of Rheumatology(ACR)criteria were reclassified using 2007 European Medicines Agency(EMA)algorithm modified by 2012 Chapel Hill Consensus Conference(CHCC)definitions,aiming to evaluate the new classification criteria for the diagnosis of PAN.A total of 113 PAN patients admitted to Peking Union Medical College Hospital from January 2002 to December 2018 were retrospectively analyzed,who were classified into three subtypes including 9 patients with cutaneous,80 with classic and 24 Hepatitis B virus(HBV)associated PAN.All patients were reclassified according to 2007 EMA algorithm using CHCC 2012 definitions.As a result,7 patients were diagnosed as microscopic polyangiitis(MPA)and 19 patients with unclassified vasculitis based on the new classification criteria.The diagnostic rate of PAN was gradually declined as the classification criteria of vasculitides was update.However,there are quite a few PAN patients in China,whom rheumatologists should pay attention to the early diagnosis and treatment.