摘要
目的 观察小于胎龄儿 (smallforgestationalageinfants,SGA)的临床分型情况 ,并评价我国现行的SGA分型方法与SGA定义分型的相关性。方法 采用回顾性调查方法 ,根据“试行草案”中重量指数 (ponderalindex ,PI)及身长 /头围比值分型标准对 417例SGA进行临床分型 ,并以SGA的定义分型为“金标准” ,评价PI及身长 /头围比值的分型结果。结果 ( 1)按PI、身长 /头围比值及定义的标准 ,417例SGA中匀称型分别为 3 76例 ( 90 17% )、3 76例 ( 90 17% )和 187例 ( 4 4 84% )。PI与身长 /头围比值的诊断符合率为 80 82 % ,但反映诊断结果一致性的指标Kappa值为 -0 0 93。 ( 2 )PI和身长 /头围比值分型与SGA定义分型的符合率分别为 49 88%和 50 84%。与定义标准相比 ,PI及身长 /头围比值的敏感性为 91 84%～ 96 3 8% ,特异性为 9 3 0 %～ 2 5 86% ,假阳性为 74 14 %～ 90 70 % ,诊断指数为 4 95%～ 17 70 % ,Kappa值为 0 0 70～ 0 167。 ( 3 )ROC曲线分析显示 ,足月儿和早产儿PI值的ROC曲线下面积分别为 0 63 5和 0 698;身长 /头围比值法的ROC曲线下面积为 0 673。结论 我国目前“试行草案”中PI及身长 /头围比值两种分型标准不够合理 ,有进一步探讨的必要。
Objective To study the validity of criteria currently used in China for the classification of symmetric small for gestational age infants (SGA) as compared with its definition Methods This study included 417 inpatients diagnosed as SGA in authors′ hospital from January 1998 to June 2002 Symmetric SGA was diagnosed by the following three criteria: (1) the Ponderal Index (PI), (2) the crown heel length to head circumference ratio (BL/HC) issued in Chin J Pediatr (1988;26:164 165), as well as (3) the SGA definition The definition criterion was considered as the 'gold standard' The sensitivity, specificity, false positive and negative values, positive and negative predictive values, exact agreement ratio, diagnosis index, and Cohen′s Kappa value were used to evaluate the validity and agreement of the methods of PI and BL/HC Receiver Operating Characteristic ( ROC ) analysis was used to evaluate the validity of the diagnosis Results Of 417 SGA infants, 376 (90 17%), 376 (90 17%) and 187 (44 84%) subjects were diagnosed as symmetric type with PI, BL/HC and the definition criteria, respectively (2) The agreement rate and Kappa value between PI and BL/HC was 80 82% and -0 093(SEM 0 026), respectively And the agreement rates between PI or BL/HC and the definition criterion were 49 88% and 50 84%, respectively As compared with the definition criterion, the PI and BL/HC methods had sensitivities of 91 8%-96 4%, specificities of 9 3%-25 9%, positive predictive values of 45 8%-51 1%, negative predictive values of 72 7%-82 8%, diagnosis indices of 4 9%-17 7% and Kappa values of 0 070-0 167 (3) The areas under the ROC curves in full term and preterm infants by PI method were 0 635 (95% CI , 0 573-0 697) and 0 698 (95% CI , 0 622-0 725), respectively PI cutoffs at 2 47 in full term SGA, at 2 43 in preterm SGA, and BL/HC cutoff at 1 43 produced the maximum diagnosis indices that were 24 7%, 39 6% and 33 7%, respectively When the PI at 2 50 (full term), PI at 2 31(preterm) and BL/HC values at 1 46, the sensitivity closed mostly to the specificity The sensitivities and specificities in full term and preterm infants were 59 4% and 59 3%, 65 3% and 65 5%, and 66 3% and 65 5%, respectively Conclusion In the classification of SGA, the results showed a poor agreement between PI or BL/HC and the definition criterion The results suggested that the current cutoffs of PI and BL/HC might not be appropriate for the diagnosis of symmetric SGA Low AUC suggested that PI and BL/HC could not give a valid diagnosis at any cutoffs
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2003年第9期697-702,共6页
Chinese Journal of Pediatrics
关键词
小于胎龄儿
临床分型
人体质量指数
身长
体重
Infant, small for gestational age
Body mass index
Body weights and neasures
Reference standards
