临床表现诊断饮水型氟骨症价值评析

The value evaluation of the clinical diagnosis of Endemic fluorosis

目的比较饮水型地方性氟骨症临床表现诊断与X线诊断的差异,评价临床表现对该病的诊断价值,为按照临床表现对该病进行早期诊断提供理论依据。方法调查244例高氟病区居民的临床症状和体征,统计各种症状、体征检出率,并依据临床表现进行诊断与分度;拍摄骨关节X线照片,按照WS192-1999标准进行X线诊断与分度;比较临床与X线方法诊断及分度结果的差异;计算临床诊断方法的真实性、可靠性等指标,并根据上述指标对其诊断价值进行评价。结果饮水型地方性氟骨症最常见的临床表现为骨关节的疼痛和僵硬;临床和X线方法检出率分别为69.3%和63.1%,两种方法诊断结果的差异没有统计学意义(P>0.05);临床与X线诊断方法的符合率为69.3%;二者在分度上表现出交叉;临床诊断方法灵敏度为80.5%,特异度为50.0%,假阴性率为19.5%,假阳性率为50.0%;ROC曲线下面积为0.653。结论临床与X线诊断方法对氟骨症的检出率相同。依据临床表现对该病进行诊断的特异度不高,可能由于临床表现为非客观性指标,不好控制;临床表现诊断法误诊率较高;临床诊断与X线诊断方法对该病的诊断结果较一致,虽不可单独诊断,却可为确诊该病提供重要线索。

Objective To compare the diagnostic differences between the clinical and X-ray for Endemic skeletal fluorosis caused by exposure to water drinking.To assess the diagnostic value of the clinical manifestation of the disease,so as to provide theoretical basis for the early diagnosis for the disease.Methods 244 residents in fluorosis areas were examined for clinical signs and symptoms,the rate of every signs and symptoms were calculated,the diagnosis was made according to the manifestation of fluorosis;X-ray photographs of skeletal and joint were taken for 244 residents,the X-ray diagnostic results were made in accordance with the standard of WS192-1999;the diagnostic results and the difference of the both methods of clinical and X-ray were compared;the validity and reliability indicators of the clinical diagnosis were calculated,and the diagnostic value of the clinical diagnosis were evaluated according with the above indicators.Results The most common manifestations were pain and stiff of bone and joint,the accurately diagnostic rates of clinical and X-ray were 69.3% and 63.1% respectively,the difference between the results of the two methods was not statistically significant（P〉0.05）;the coincidence rate was 69.3%,the cross was appeared in the sub-degree;the sensitivity was 80.5%,the specificity was 50.0%,the false negative rate was 19.5%,the false positive rate was 50.0%,the area under ROC curve was 0.653.Conclusions The relevance ratio of clinical and X-ray diagnosis is consistent in Endemic fluorosis,the specificity of the early diagnosis by the clinical manifestation for the disease is low,which maybe due to the non-objectivity of the clinical manifestations;the false positive rate are high,and it should to be controlled.The results of the clinical and X-ray diagnosis for this disease is highly consistent.Although the way can not be separately used,it can provide important clues.