物理诊断对内科门诊功能性疾病的诊断价值

Clinical value of physical diagnosis for patients with functional illness at an ambulatory setting

目的评价物理诊断（询问病史和体检）对于普通内科门诊功能性疾病的诊断价值。方法连续纳入2008年10月10日至17日就诊于北京协和医院普通内科门诊的145例患者，并进行12个月的随访。结果145例患者失访18例（12．4％）。45例（35．4％）患者经随访确诊为医学不能解释的症状（MUS）。物理诊断评估MUS的敏感性为82．2％，特异性为95．1％，阳性似然比为16．9，阴性似然比为0．19，阳性预期值为90．2％，阴性预期值为90．7％，总体准确率为90．6％。结论MUS是内科门诊常见的临床现象，物理诊断评估MUS可靠性较高。在物理诊断的基础上合理选择辅助检查有助于提高MUS的诊治水平。

Objective To evaluate diagnostic accuracy based on patient history and physical examinations in medical outpatients. Methods Totally, 145 consecutive patients visiting general internal medicine clinic at a university-affiliated teaching hospital during October 10 to 17, 2008 were recruited into the study and followed-up for 12 months. Results Eighteen of 145 patients （ 12.4% ） were lost to follow- up. Diagnosis was confirmed by follow-up for 45 （ 35.4% ） of those with medically unexplained symptoms （MUS）. Sensitivity of physical diagnosis for those with MUS was 82. 2 percent, with specificity of 95.1 percent, likelihood ratios of positive and negative results of 16. 9 percent and 0. 19 percent, its positive and negative prediction values of 90. 2 percent and 90.7 percent, and overall accuracy of 90. 6 percent, respectively. Conclusions MUS was common in medical clinical practice. Preliminary diagnosis for MUS based on patient history and physical examinations has been proved remarkably reliable. Carefully selected auxiliary laboratory evaluation combined with physical diagnosis is important for management of MUS.