非功能性消化不良患者临床初步诊断的准确性研究  

STUDY ON THE ACCURACY OF PROVISIONAL DIAGNOSES OF PATIENTS WITH DYSPEPSIA

作　　者：周晓东[1] 于皆平[1] 冉宗学[1] 刘诗权[1] 胡国勇[1] 魏鹏翅[1] 

机构地区：[1]武汉大学人民医院消化内科,武汉430060

出　　处：《中国内镜杂志》2002年第7期14-16,共3页China Journal of Endoscopy

摘　　要：目的 :评估消化不良患者临床初步诊断与胃镜诊断的一致性。方法 :对 2 1 1例因消化不良于门诊后接受了胃镜检查的患者进行回顾性研究。初步诊断和胃镜诊断结果分别来自门诊病历和胃镜报告 ,统计分析导致消化不良的四种器质性疾病前后诊断的一致性 ,并以胃镜诊断结果为标准分析初步诊断的准确性情况。结果 :前后诊断的总符合率为 55 .5 %到 97.2 %。消化性溃疡、胃食管反流性疾病、良性食管狭窄和胃癌的kappa系数分别为 0 .1 2、0 .2 6、0 .49和 0 .2 3 ,四种疾病诊断的阴性预测值皆较高 ,而阳性预测值只有胃食管反流性疾病达 65 % ,其他皆在 43 %以下。只有 2 5 %的胃癌患者得到了准确的初步诊断。结论 :由于消化不良症状的不确定性使得临床医师在初步诊断时难以取得较为理想的准确性水平 ,因此 ,尽管对消化不良患者的病史回顾及体格检查很重要 ,但很多时候更应重视胃镜检查对消化不良的诊断价值 ,尤其对于器质性疾病所引起者 。Objective:To assess the agreement between provisional and endoscopic diagnoses for patients with dyspepsia undergoing initial endoscopy.Method:This was a retrospective study of 211 consecutive patients who had an upper endoscopy for dyspepsia. The provisional diagnoses were abstracted from the patients' medical records, and the endoscopic diagnoses were obtained from the original endoscopy reports. Agreement was considered separately for each of the 4 diagnoses examined(peptic ulcer, OERD,gastric cancer, and benign esophageal stricture).Results:Crude percentage agreement ranged from 55.5% to 97.2%.Kappa scores revealed poor agreement:pepticulcer (0.12);gastroesophageal reflux disease (0.26);benign esophageal stricture(0.49) and gastric cancer(0.23).Positive and negative predictive values for gastric cancer and benign esophageal stricture and peptic ulcer showed that agreement for a negative diagnosis was almost perfect, but the agreement was low for a positive diagnosis. Only 25% patients with gastric cancer were given a accurate diagnosis. Conclusions:This study ,which utilized statistical techniques to adjust for chance agreement and the role of disease prevalence, support the proposition that the ill-defined nature of dyspepsia symptoms prevents the attainment of greater accuracy in provisional diagnosis than that currently being observed. Thus the gastroenterologists sometimes should increase reliance on endoscopy.

关 键 词：非功能性消化不良 诊断 胃镜 器质性疾病 临床研究 

分 类 号：R57[医药卫生—消化系统]