特应性皮炎张氏诊断标准在苏南地区青少年和成人的适用性评估  

Evaluation of the applicability of the Zhang's diagnostic criteria for atopic dermatitis in adolescents and adults from southern Jiangsu

作　　者：徐文[1] 凌昕 施辛[3] 万聪翀 戴彩红 杨志刚 陈玲玲 Xu Wen;Ling Xin;Shi Xin;Wan Congchong;Dai Caihong;Yang Zhigang;Chen Lingling(Department of Dermatology,Changshu No.2 People's Hospital,Changshu 215500,Jiangsu,China;Department of Dermatology,Suzhou Ninth People's Hospital,Suzhou 215200,Jiangsu,China;Department of Dermatology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu,China;Department of Dermatology,The Third Affiliated Hospital of Soochow University,Suzhou 213000,Jiangsu,China;Department of Dermatology,Jiangsu Shengze Hospital,Suzhou 215227,Jiangsu,China;Department of Dermatology,The 904th Hospital of Joint Logistics Support Forces,Wuxi 214000,Jiangsu,China;Department of Dermatology,Suzhou Municipal Hospital,Suzhou 215002,Jiangsu,China)

机构地区：[1]常熟市第二人民医院皮肤科,常熟215500 [2]苏州市第九人民医院皮肤科,苏州215200 [3]苏州大学附属第二医院皮肤科,苏州215004 [4]苏州大学附属第三医院皮肤科,常州213000 [5]江苏盛泽医院皮肤科,苏州215227 [6]联勤保障部队第904医院皮肤科,无锡2214000 [7]苏州市立医院本部皮肤科,苏州1215002

出　　处：《中华皮肤科杂志》2022年第12期1084-1088,共5页Chinese Journal of Dermatology

基　　金：第五批姑苏卫生人才培养项目(GSWS2019055);苏州市2020年度第二十九批科技发展计划(民生科技)项目(SS202076)。

摘　　要：目的评估特应性皮炎(AD)张氏诊断标准在苏南地区青少年和成人的适用性。方法收集2019年5月至2021年5月来自苏南地区7家医院皮肤科初诊为湿疹或AD的病例1769例。由研究人员自行设计调查表,主要包括患者的个人信息、相关病史及临床特征、实验室检查等内容,由患者和皮肤科医生共同完成标准化问卷。以Hanifin-Rajka标准为金标准,分别评估Williams标准、张氏标准、日本皮肤病学会标准的敏感性和特异性。结果1769例患者中男759例(42.9%),女1010例(57.1%),年龄(32.2±8.2)岁(12~79岁)。AD患者的临床特征中瘙痒的发生率占首位(96.7%,883/913)。以Hanifin-Rajka标准为"金标准",913例(51.6%)被诊断为AD;张氏标准诊断敏感性为92.6%(845/913),特异性为73.2%(627/856);Williams标准诊断敏感性为87.8%(802/913),特异性为81.3%(696/856);JDA标准敏感性为96.9%(885/913),特异性为68.9%(590/856)。张氏标准与Williams标准诊断一致性一般(Kappa值=0.61,P=0.009),张氏标准与JDA标准诊断一致性高(Kappa值=0.85,P=0.001),Williams标准与JDA标准诊断一致性一般(Kappa值=0.51,P=0.013)。结论与Hanifin-Rajka标准相比,张氏标准对于苏南地区青少年和成人AD的诊断表现出良好的敏感性和特异性,但瘙痒对AD的诊断亦非常重要。Objective To evaluate the applicability of the Zhang's diagnostic criteria for atopic dermatitis(AD)in adolescents and adults from southern Jiangsu.MethodsA total of 1769 patients were collected,who were newly diagnosed with eczema or AD in departments of dermatology of 7 hospitals in southern Jiangsu from May 2019 to May 2021.A standardized survey interview was conducted with patients by dermatologists using a self-designed questionnaire,which included patient's personal information,relevant medical history,clinical characteristics,laboratory tests,etc.Using Hanifin-Rajka criteria as the gold standard,the sensitivity and specificity of the Williams criteria,Zhang's criteria and Japanese Dermatological Association(JDA)criteria were evaluated,separately.Results Among the 1769 patients,there were 759(42.9%)males and 1010(57.1%)females,aged 32.2±8.2 years(range,12-79 years).Pruritus was the most common clinical feature among the AD patients(883/913,96.7%).When using the Hanifin-Rajka criteria as the gold standard,913(51.6%)subjects were diagnosed with AD;the sensitivity of Zhang's criteria reached 92.6%(845/913),and its specificity was 73.2%(627/856);the sensitivity of Williams'criteria was 87.8%(802/913),and its specificity was 81.3%(696/856);the sensitivity of JDA criteria reached 96.9%(885/913),and its specificity was 68.9%(590/856).The consistency in the diagnosis of AD was moderate between the Zhang's criteria and Williams criteria(K_(appa)=O.61,P=0.009),was relatively high between the Zhang's criteria and JDA criteria(Kappa=0.85,P=0.001),and was moderate between the Williams criteria and JDA criteria(K_(appa)=0.51,P=0.013).Conclusions Compared with the Hanifin-Rajka criteria,the Zhang's criteria exhibit good sensitivity and specificity for the diagnosis of AD among adolescents and adults in southern Jiangsu.However,pruritus remains important for the diagnosis of AD.

关 键 词：皮炎 特应性 诊断 敏感性与特异性 标准 瘙痒 免疫球蛋白E 苏南地区 

分 类 号：R758.2[医药卫生—皮肤病学与性病学]