三种诊断标准在特应性皮炎患者中的对比分析  

A comparative study of three diagnostic criteria for atopic dermatitis

作　　者：赵伟佳 栗玉珍[1] ZHAO Weijia;LI Yuzhen(Second Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第二医院,黑龙江哈尔滨150000

出　　处：《皮肤性病诊疗学杂志》2023年第2期120-124,共5页Journal of Diagnosis and Therapy on Dermato-venereology

摘　　要：目的对特应性皮炎(AD)及非特应性皮炎患者使用三种诊断标准进行评估,比较不同诊断标准的特异性、敏感性、差异性和一致性。方法回顾性分析2020年9月至2021年10月就诊于哈尔滨医科大学附属第二医院的AD患者,AD的初始诊断由医生根据Hanifin-Rajka标准诊断判定。收集人口学特征和临床表现等资料,分别采用Williams标准、张氏标准/中国标准及中国儿童特应性皮炎诊断标准,进行敏感性和特异性分析。以同期就诊的其他皮肤病患者作为对照,三种诊断标准的敏感性和特异性比较采用McNemar's检验,并计算Kappa值描述诊断标准的一致性。结果110例AD患者和91例非AD患者被纳入研究。敏感度最高的是中国儿童特应性皮炎诊断标准(83.6%),但其特异度最低,仅为59.3%。特异度最高的是张氏标准/中国标准和Williams标准,两者均达90.1%。在阳性预测值和阴性预测值方面,张氏标准/中国标准(分别为90.2%、75.2%)均优于其他标准。假阴性率最高的是Williams标准(29.1%)。假阳性率最高的是中国儿童特应性皮炎诊断标准(40.7%)。Youden指数和Kappa系数最高的是张氏标准/中国标准,Kappa系数为0.645(95%CI:0.541~0.748,P<0.05)。结论张氏标准/中国标准的统计学优势略大于Williams标准和中国儿童特应性皮炎诊断标准,与金标准具有高度一致性。Objective To compare the specificity,sensitivity,variability and consistency among three different diagnostic criteria for atopic dermatitis(AD)in subjects with and without AD.Methods We retrospectively analyzed patients with AD initially diagnosed according to the Hanifin Rajka criteria at our clinic between September 2020 and October 2021.Demographic characteristics,clinical manifestations and the results of laboratory tests were used to analyze the sensitivity and specificity of Williams criteria,Zhang's criteria/Chinese criteria and Chinese diagnostic criteria for childhood AD.Patients with other dermatological diseases visiting our clinic during the same period were used as controls.The sensitivity and specificity of the three diagnostic criteria were compared using McNemar's test,while Kappa values were used to determine the consistency of the diagnostic criteria.Results One hundred and ten patients with AD and 91 patients without AD were included in this analysis.The highest sensitivity and lowest specificity were Chinese diagnostic criteria for childhood AD(83.6%,59.3%).Both Zhang's criteria/Chinese criteria and Williams criterion displayed the highest specificity(90.1%for both).Both positive and negative predictive values(90.2%,75.2%)were higher for Zhang's criteria/Chinese criteria than the others.The Williams criteria exhibited the highest false negative rate(29.1%),while the highest false positive rate was found for the Chinese diagnostic criteria for AD in children(40.7%).The Zhang's criteria/Chinese criteria displayed the highest Youden index and Kappa coefficient,with a Kappa coefficient of 0.645(95%CI:0.541-0.748,P<0.05).Conclusion The statistical advantage of Zhang's criteria/Chinese criteria is slightly greater than that of Williams criteria and Chinese diagnostic criteria for AD in children,which is in high agreement with the gold standard.

关 键 词：特应性皮炎 诊断标准 灵敏度 特异度 

分 类 号：R758.2[医药卫生—皮肤病学与性病学]