中国实用儿科杂志

中国实用儿科杂志 ›› 2021, Vol. 36 ›› Issue (12): 947-950.DOI: 10.19538/j.ek2021120614

• 论著 • 上一篇    下一篇

6岁以下儿童哮喘诊断标准验证的多中心研究

  

  1. 执笔作者：任　洁
    参与专家（排名不分先后）：任　洁（上海交通大学医学院附属上海儿童医学中心）；张平波（上海童杏儿科门诊部）；邵　洁（上海交通大学医学院附属瑞金医院）；华　丽（上海交通大学医学院附属新华医院）；白沙沙（上海交通大学医学院附属新华医院）；张中平（河北省儿童医院）；靳秀红（河南省儿童医院）；曾莉君（广州医科大学附属第一医院）；张蓉芳（甘肃省妇幼保健院）；蒋　敏（广西医科大学第一附属医院）；侯　伟（西安交通大学第二附属医院）；王　宁（西安市儿童医院）；孙　新（空军军医大学西京医院）；陈惠文（南宁市妇幼保健院）；秦维娜（保定市儿童医院）；王继春（内蒙古医科大学附属医院）；马金海（宁夏医科大学总医院）；田　军（杭州市萧山区第一人民医院）；陆婉秋（贵州医科大学附属医院）；尚云晓（中国医科大学附属盛京医院）；成焕吉（吉林大学第一医院）；张素琴（郑州大学第一附属医院）；王桂兰（南方医科大学附属中山市博爱医院）；吴福玲（滨州医学院附属医院）；王晓荣（上海解码医学检验所）；潘加奎（上海解码医学检验所）；姚　力（浙江省象山县中医医院医疗健康集团总院）；洪建国（上海交通大学附属上海第一人民医院）；鲍一笑（上海交通大学医学院附属上海儿童医学中心，上海童杏儿科门诊部）
  • 出版日期:2021-12-06 发布日期:2022-02-18
  • 通讯作者: 鲍一笑，电子信箱：drsmilebao@163.com；洪建国，电子信箱：hongjianguo@hotmail.com

Multi-center study on the verification of diagnosis criteria for asthma in children under 6 years of age

  • Online:2021-12-06 Published:2022-02-18

摘要： 目的　建立客观、稳定的6岁以下儿童哮喘诊断标准。 方法　2020年9月至12月，共22个医疗中心纳入2263例6岁以下有喘息史的患儿相关信息，设计标准化病历系统，建立数据库。将喘息患儿根据现有诊断标准分为哮喘组1151例和非哮喘组1112例，并以“33111评分法”重新诊断，检测其对哮喘组和非哮喘组诊断的特异度、敏感度。结果　哮喘组患儿依据“33111评分法”仍诊断为哮喘者1068例，未诊断哮喘者83例；非哮喘组患儿依据“33111评分法”仍未诊断哮喘者950例，诊断为哮喘者162例。以现有诊断方法为依据，“33111评分法”诊断的ROC曲线下面积为0.934，95%可信区间（0.924，0.934），灵敏度为0.928，特异度为0.854。阳性预测值86.80%，阴性预测值92.00%，阳性似然比6.36，阴性似然比0.084，Youden指数0.752。 结论　经多中心大样本验证，“33111评分法”稳定性较强，指标客观，可操作性强，具有较高临床应用价值。

关键词: 哮喘, 儿童, 诊断标准, 多中心, 大样本, 验证

Abstract: Objective　Toestablish objective and stable diagnostic criteria for asthma in children under the age of 6. Methods　In total of 22 medical centers，2263 children with less than 6 years of age with a wheezing history were included in the related information from September to December 2020. A standardized medical record system was designed，and a database was established. Wheezing children were divided into 1151 asthma and 1112 non-asthma groups according to the existing diagnostic criteria and rediagnosed with "33111 scoring system" to test for their specificity and sensitivity to the two groups. Results　In the asthma group，1068 children were still diagnosed with asthma according to the "33111 scoring system"，while 83 cases were not diagnosed as asthma. In the non-asthmatic group，950 children were still undiagnosed with asthma and 162 children were diagnosed with asthma according to "33111 score"  among the wheezing children diagnosed as non-asthma according to the existing guidelines，950 cases were also diagnosed as non-asthma according to the "33111 scoring system"，while 162 cases were diagnosed as asthma. Compared with the existing guidelines，the area under the ROC curve of the "33111 scoring system" was 0.934，with a 95% confidence interval（0.924，0.934）. The positive predictive value was 86.80%. The negative predictive value was 92.00%. The positive likelihood ratio was 6.36. The negative likelihood ratio was 0.084. The Youden index was 0.752. Conclusion　The "33111 scoring system" has been proved to have strong stability and high operability through multi-center and large sample verification，indicating it has high clinical value.

Key words: asthma, child, diagnostic criteria, multi-center, large-scale, validation