编译者：谢荣华，西京医院临床免疫科

目  的:

2010年美国风湿病学会（ACR）的暂行标准和2011年用于调查和临床研究的自我报告修订被广泛用于纤维肌痛综合征的诊断。为了该确定标准的有效性、有用性、潜在问题和需要修改的地方，评估了2010-2016年发表的多个研究报告，以便对标准进行2016年的更新。

方  法:

回顾了14项验证研究，这些研究将2010/2011年的标准与ACR 1990年的分类和临床标准进行了比较，同时也回顾了流行病学、临床和数据库研究，这些研究均强调了重要的标准级别变量。基于1990年和2010/2011年标准之间的定义差异，我们将85%的敏感性和90%的特异性解释为极好的一致性。

结  果:

与1990年和临床标准相比，2010/2011年标准的中位敏感性和特异性分别为86%和90%。2010/2011标准在应用于区域疼痛综合征时导致了错误的分类，但是当加入一个修改的广泛疼痛标准（“广义疼痛标准”）时，错误的分类被消除了。基于上述数据和临床使用数据，我们对2010/2011年纤维肌痛症标准进行了(2016)修订。

结  论:

纤维肌痛症诊断标准具有良好的敏感性和特异性。这一修订结合了医生和患者问卷标准，最大限度地减少了对区域疼痛障碍的错误分类，并消除了以前令人困惑的关于排除诊断的建议。以医生为基础的标准对个别病人的诊断是有效的，该标准的自我报告版本对个别患者的临床诊断无效，但对研究研究有效。这些变化允许这些标准作为诊断标准，同时仍然对分类有用。

文献来源：

Semin Arthritis Rheum. 2016 Dec;46(3):319-329. doi:10.1016/j.semarthrit.2016.08.012. Epub 2016 Aug 30.

2016 Revisions to the 2010/2011fibromyalgia diagnostic criteria.

Wolfe F1, Clauw DJ2, Fitzcharles MA3, Goldenberg DL4, Häuser W5, Katz RL6, Mease PJ7, Russell AS8, Russell IJ9, Walitt B10.

Abstract

OBJECTIVES:

The provisional criteria of theAmerican College of Rheumatology (ACR) 2010 and the 2011 self-reportmodification for survey and clinical research are widely used for fibromyalgiadiagnosis. To determine the validity, usefulness, potential problems, and modificationsrequired for the criteria, we assessed multiple research reports published in2010-2016 in order to provide a 2016 update to the criteria.

METHODS:

We reviewed 14 validation studiesthat compared 2010/2011 criteria with ACR 1990 classification and clinicalcriteria, as well as epidemiology, clinical, and databank studies thataddressed important criteria-level variables. Based on definitional differencesbetween 1990 and 2010/2011 criteria, we interpreted 85% sensitivity and 90%specificity as excellent agreement.

RESULTS:

Against 1990 and clinicalcriteria, the median sensitivity and specificity of the 2010/2011 criteria were86% and 90%, respectively. The 2010/2011 criteria led to misclassification whenapplied to regional pain syndromes, but when a modified widespread paincriterion (the "generalized pain criterion") was addedmisclassification was eliminated. Based on the above data and clinic usagedata, we developed a (2016) revision to the 2010/2011 fibromyalgia criteria.Fibromyalgia may now be diagnosed in adults when all of the following criteriaare met: CONCLUSIONS: The fibromyalgia criteria have good sensitivity andspecificity. This revision combines physician and questionnaire criteria,minimizes misclassification of regional pain disorders, and eliminates thepreviously confusing recommendation regarding diagnostic exclusions. Thephysician-based criteria are valid for individual patient diagnosis. Theself-report version of the criteria is not valid for clinical diagnosis in individualpatients but is valid for research studies. These changes allow the criteria tofunction as diagnostic criteria, while still being useful for classification.