儿童偏头痛的诊断标准

Exploration on Diagnostic Criteria of Migraine in Children

目的研究儿童偏头痛的临床特点,探讨儿童偏头痛的诊断标准。方法符合慢性头痛诊断且排除其他疾病的患儿346例,均具有完整的病史资料。分析偏头痛的临床特点,采用评价诊断试验方法,以ICHD-Ⅱ儿童偏头痛诊断标准为金标准,以偏头痛的临床特征为变量,探讨儿童偏头痛的诊断标准。结果1.慢性头痛346例患者中,157例(45.4%)符合ICHD-Ⅱ儿童偏头痛诊断标准。男75例,女82例。2.偏头痛类型中以可能的偏头痛最多见,占68.8%(108/157例)。主要的不符合指标是缺乏消化道伴随症状;其次为无先兆型偏头痛19.7%(31/157例)。3.偏头痛诊断标准最敏感的单个指标为头痛伴随症状,灵敏度为70.7%、特异度为83.6%,阳性预测值为78.2%,阳性似然比4.31,ROC曲线下面积(AUC)达0.771。最佳组合指标为持续时间1～72h、中重度头痛、头痛伴随症状,灵敏度为52.2%,特异度96.2%,阳性预测值为90.1%,阳性似然比13.7,AUC达0.657。结论儿童偏头痛的诊断标准最敏感的单个诊断指标为头痛伴随症状,最佳组合诊断指标为头痛持续时间1～72h、中重度头痛、头痛伴随症状。

Objective To explore the clinical characteristics and diagnostic criteria of migraine in children. Methods The migraine clinical characteristics of patients that consistent with the chronic headache diagnostic criteria, excluding other diseases,were analyzed. 1CHD - Ⅱ childhood migraine diagnostic criteria was used as gold standard to explore the migraine diagnostic criteria in children. Results 1. In 346 patients, 157 fitted 1CHD - Ⅱchildhood migraine diagnostic criteria. 2. Type of migraine ： probable migraine was the most common （68.8%） , the most commonly unfulfilled criterion was associated gastroenteritis symptoms; migraine without aura was the second （19.7%）. 3. The migraine diagnostic criteria： the most important single -variable was headache associated symptoms, with sensitivity of 70.7%, specificity of 83.6%, the positive predictive value（PPV） was 78.2% ,positive likelihood ratio （PLR） was 4.31 and area under curve（AUC） was 0.771. The most important three -variables was headache duration of 1 -72 hours, moderate - severe headache and headache associated symptoms, with the sensitivity of 52.2%, specificity of 96.2%, the PPV was 90.1%, the PLR was 13.7 and the AUC was 0. 657. Conclusions The most important single - variable is headache associated symptoms, the most important three - variables are headache duration 1 - 72 hours, moderate - severe headache and headache associated symptoms.