摘要
目的探讨建立适用于中国儿科临床实践的6岁以下儿童哮喘诊断标准。方法纳入2016年10月至2017年7月于上海交通大学医学院附属新华医院儿童哮喘门诊6岁以下患有喘息症状的儿童785例,采用问卷形式,收集相关变量,建立数据库。通过文献研究和德尔菲法专家征询的方法,获得可用于哮喘诊断的有效参数,进行数据库分析。先行单因素分析,筛选出有统计意义的变量,再行多因素Logistic回归分析的方法建立儿童哮喘/非哮喘的诊断模型,并根据模型中各变量的β值赋予分值,建立评分系统。通过受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)下面积评价该模型及其评分系统的诊断效能。结果经上述方法筛选出5项参数纳入多因素Logistic回归模型,并根据模型中各参数的β值赋予分值,初步建立6岁以下儿童哮喘诊断标准:喘息发作频率累计≥4次(3分)、是否存在可逆性气流受限(3分)、是否存在过敏性鼻炎和(或)特应性皮炎(1分)、一级亲属中是否存在过敏史(1分)、体内或体外变应原检测结果是否阳性(1分)。该模型及其评分系统ROC曲线下面积为0.908,总体具有诊断价值。根据ROC曲线可知,最佳诊断界值为4分,此时诊断灵敏度为0.958,特异度为0.859。结论诊断模型及评分系统指标简化、实用性强,可作为中国6岁以下儿童哮喘诊断标准,下一步计划拟进行大规模的验证研究,在再优化的条件下临床推广应用。
Objective To establish diagnostic criteria for asthma in children aged6 years in China. Methods From October 2016 to July 2017,a total of 785 wheezing children aged 6 years were enrolled from a asthma clinic for children in Xinhua hospital affiliated to Shanghai Jiao Tong University School of Medicine. The questionnaire was used to collect data for a database of childhood asthma. The method of literature search and expert consultation was used to select parameters for the diagnosis of asthma. Univariate analysis was first applied to study the significance of these parameters,and multivariate logistic regression analysis was then performed to establish diagnostic model for asthma in children. According to the β value of the regression model,the scoring system was established. Area under receiver operating characteristic curve was used to test the differential diagnostic efficacy of the scoring system. Results The diagnostic criteria for asthma in children aged6 years was developed based on the logistic regression model,and the scoring system was established according to the β value of the model. The main contents included accumulated times of wheezing attacks ≥ 4（3 points）;the existence of reversible airflow limitation（3 points）;the existence of allergic rhinitis and/or atopic dermatitis（1 point）;the existence of allergic history among first-degree relatives（1 point）;positive allergen test in vivo or in vitro（1 point）. The area under ROC curve of the scoring system was 0.908,indicating that the diagnostic model and scoring system was of great value in diagnosis of asthma in children aged6 years. Based on the ROC curve,the optimal cut-off value for asthma diagnosis was four points,with a sensitivity of 95.8% and a specificity of85.9%. Conclusion The diagnostic criteria for asthma in children aged6 years has been established preliminarily,which is simplified and practical and need a large-scale prospective study for further validation and optimization before clinical application.
作者
无
鲍一笑
The Subspecialty Group of Pediatric Allergy and Asthma;the Society of AUergic Reaction;Chinese Medical Association;Cooperative Group of Asthma;the Subspecialty Group of Respiratory;the Society of Pediatrics;Chinese Medical Association;The Editorial Board of Chinese Journal of Practical Pediatrics
出处
《中国实用儿科杂志》
CSCD
北大核心
2018年第11期870-876,共7页
Chinese Journal of Practical Pediatrics
关键词
哮喘
诊断标准
儿童
文献研究
专家征询
asthma
diagnostic criteria
children
literature search
expert consultation
