症状相关概率在胃食管反流性咳嗽诊断中的应用价值  

Optimal cut-off point of symptom association probability in the diagnosis of gastroesophageal reflux-induced chronic cough

作　　者：陈强[1] 徐镶怀[1] 余莉[1] 梁四维[1] 吕寒静[1] 邱忠民[1] 

机构地区：[1]同济大学附属同济医院呼吸内科,上海200065

出　　处：《中华结核和呼吸杂志》2013年第10期746-750,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然基金面上项目（81170079）;上海市级医院适宜技术项目（SHDC12012211） 通信作者：邱忠民,Email：[e-mail]

摘　　要：目的 通过前瞻性研究探讨症状相关概率（SAP）诊断胃食管反流性咳嗽（GERC）的最佳标准,以提高诊断精确性.方法 选择2011年7月至2013年2月连续在同济大学附属同济医院呼吸内科门诊就诊的可疑GERC患者,进行多通道食管腔内阻抗-pH值监测检查,结合患者日记卡上咳嗽记录计算SAP,并经药物抗反流试验证实诊断.根据最高的Youden指数确立SAP诊断GERC的最佳标准,分析其敏感度、特异度、阳性预测值和阴性预测值,计算AUCROC和Kappa值,并与国内外SAP 诊断标准相比较.结果 在纳入的103例中,87例（84.5％）患者最终确诊为GERC,其中酸反流引起者54例（62.1％）,非酸反流引起者33例（37.9％）.SAP≥80％时Youden指数最高（0.372）,AUCROC 值为0.686,Kappa值为0.264,诊断GERC的敏感度为74.7％,特异度62.5％,阳性预测值91.5％,阴性预测值31.3％,维持较高诊断敏感度和特异度之间的平衡,优于国内SAP≥75％和国际≥95％的诊断标准.结合DeMeester积分≥12.7的条件,则AUCROC值为0.820,Kappa值0.689,敏感度87.0％,特异度76.0％,阳性预测值94.1％,阴性预测值80.0％,诊断效率和精确性与单纯SAP≥80％比较有进一步提高.结论 SAP≥80％可能是GERC的更合适诊断标准.Objective To explore the optimal cut-off point of symptom association probability （SAP） in the diagnosis of gastroesophageal reflux-induced chronic cough （GERC） and therefore to improve the diagnostic accuracy.Methods Patients with suspected GERC consecutively referred to our respiratory clinic were enrolled into this prospective study between July 2011 and February 2013.After multi-channel intraluminal esophageal impedance and pH monitoring,SAP was calculated by associating the cough recordings on the patients＇ diary with the detected reflux.GERC was confirmed when there was a favorable response to the following anti-reflux therapy despite the laboratory findings.The optimal cutoff point of SAP was defined according to the highest Youden index.Then,the sensitivity,specificity,positive and negative predictive values,the area under the curve of ROC,and the Kappa value for the optimal cut-off point of SAP was calculated and compared to those of SAP standards currently used in China or generally accepted in the diagnosis of GERC.Results During the study period,103 patients with suspected GERC were recruited.Among them,GERC was confirmed in 87 patients （84.5%）,including 54 patients （62.1%） due to acid reflux and 33 patients （37.9%） due to non-acid reflux.The optimal cut-off point of SAP was defined at≥ 80% based on the highest Youden index of 0.372.For the diagnosis of GERC,SAP ≥80% had the area under the curve of ROC of 0.686,the Kappa value of 0.264,the sensitivity of 74.7%,the specificity of 62.5%,positive predictive value of 91.5% and negative predictive value of 31.3% respectively,which were superior to those of SAP≥75% currently used in China,and to those of SAP≥95% （the generally accepted cut-off） in that the balance between higher sensitivity and higher specificity was maintained.When combined with DeMeester score≥ 12.7,the diagnostic accuracy of SAP ≥ 80% was further improved,with the area under the curve of ROC of 0.820,the Kappa value of 0.689,the sensitivity of 87.0%,

关 键 词：咳嗽 胃食管反流 电阻抗 食管PH监测 

分 类 号：R571[医药卫生—消化系统]