国内共识与AHA声明两种标准对川崎病诊断价值的比较  

VALUE OF DOMESTIC CONSENSUS VERSUS AHA STATEMENT IN DIAGNOSIS OF KAWASAKI DISEASE

作　　者：王先东 王本臻[1] 单光颂 邴振 纪志娴[1] 李自普[1,2] WANG Xiandong;WANG Benzhen;SHAN Guangsong;BING Zhen;JI Zhixian;LI Zipu(Department of Heart Center,Women and Children’s Hospital of Qingdao University,Qingdao 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,山东青岛266034 [2]青岛大学附属妇女儿童医院重症医学中心,山东青岛266034

出　　处：《精准医学杂志》2023年第1期14-17,21,共5页Journal of Precision Medicine

基　　金：青岛市医疗卫生优秀人才培养项目(青卫科教字[2017]9号)。

摘　　要：目的比较《川崎病诊断和急性期治疗专家共识》(国内共识)与2017年版《川崎病的诊断、治疗及远期管理——美国心脏协会对医疗专业人员的科学声明》(AHA声明)两种标准对川崎病(Kawasaki disease,KD)的诊断价值。方法回顾性分析2016年11月—2021年3月于青岛大学附属妇女儿童医院心脏中心就诊、临床拟诊为KD的650例患儿的临床资料,以临床表现、实验室检查、超声心动图和随访最后结果(随访过程中排除其他系统性疾病)为依据,对650例患儿进行诊断,为实际确诊结果;另外再按照国内共识、AHA声明对650例患儿分别进行诊断。根据三种诊断结果分别将所有患儿分为KD组和非KD组,其中KD组又分为完全性KD组和不完全性KD组。同时再按照年龄将所有650例患儿分为≥6个月患儿组和<6个月患儿组,对每一个年龄段的患儿再依据上述方法分别进行分组。分别计算两种诊断标准诊断的灵敏度、特异度、准确率、假阳性率、假阴性率、阳性预测值和阴性预测值。结果两种诊断标准对KD、完全性KD诊断的灵敏度比较差异有显著性(P<0.05)。两种诊断标准对不完全性KD诊断的灵敏度、特异度及Youden指数比较差异有显著性(U=2.285,P<0.05)。两种诊断标准对年龄≥6个月KD诊断的灵敏度比较差异有显著性(P<0.05)。结论国内共识在诊断方面较AHA声明更加优化,明显提高了对儿童不完全性KD诊断的灵敏度,更适合我国儿童不完全性KD的诊断;但对年龄<6个月婴幼儿KD诊断的特异度尚需进一步提高。Objective To investigate the value of The Expert Consensus on Diagnosis and Acute-phase Treatment of Kawasaki Disease(hereinafter referred to as domestic consensus)versus the 2017 edition of Diagnosis,Treatment,and Long-term Management of Kawasaki Disease:A Scientific Statement for Health Professionals from the American Heart Association(hereinafter referred to as AHA statement)in the diagnosis of Kawasaki disease(KD).Methods A retrospective analysis was performed for the clinical data of 650 children who were preliminarily diagnosed with KD in Heart Center of Women and Children’s Hospital Affiliated of Qingdao University from November 2016 to March 2021,and the 650 children were diagnosed based on clinical manifestations,laboratory examination,echocardiography,and final follow-up results(with the exclusion of other systemic diseases during follow-up),which were considered the actual confirmed diagnosis.In addition,the 650 children were also diagnosed accor-ding to the domestic consensus and the AHA statement.All children were divided into KD group and non-KD group according to the three diagnostic results,and the KD group was further divided into complete KD group and incomplete KD group.At the same time,the 650 children were divided into≥6 months group and<6 months group based on age,and each age group was further grouped according to the above method.The two sets of diagnostic criteria were analyzed in terms of diagnostic sensitivity,specifi-city,accuracy,false positive rate,false negative rate,positive predictive value,and negative predictive value.Results In the diagnosis of KD and complete KD,there was a significant difference in diagnostic sensitivity between the two sets of diagnostic criteria(P<0.05).In the diagnosis of incomplete KD,there were significant differences in sensitivity,specificity,and Youden index between the two sets of diagnostic criteria(U=2.285,P<0.05).In the diagnosis of KD in children aged≥6 months,there was a significant difference in sensitivity between the two sets of diagnos

关 键 词：黏膜皮肤淋巴结综合征 诊断 敏感性与特异性 参考标准 儿童 

分 类 号：R725.5[医药卫生—儿科]