抗利尿激素分泌不适当综合征的不同诊断标准的比较研究

Comparison on values of different diagnostic criteria for syndrome of inappropriate antidiuretic hormone secretion

目的分析评价由经典、Smith、美国及欧洲建议的抗利尿激素分泌不适当综合征(SIADH)诊断标准的一致性。方法回顾性分析1990年1月至2010年10月解放军总医院收治依据经典标准诊断为SIADH的60例患者的临床资料,对另外3个标准用κ检验比较其一致性,并进行ROC曲线下面积比较。结果 (1)4个诊断标准在代谢紊乱组分中的比例,只有血浆渗透压差异存在统计学意义(P<0.05)。(2)欧洲与美国、欧洲与Smith、美国与Smith诊断标准两两之间的一致率分别为90%、83.33%、93.33%,Kappa值分别为0.58、0.43、0.8。(3)以经典标准为参照标准,欧洲、美国、Smith标准的Youden指数分别为0.917、0.817、0.75,绘制的ROC曲线下面积分别为0.958、0.908、0.875。结论 4个诊断标准的一致性较好,以经典标准为参照,欧洲标准对SIADH的诊断价值更高。

Objective To evaluate and analyze the consistency between classical diagnostic criteria for inappropriate antidiuretic hormone secretion （SIADH） and other criteria proposed by Smith or developed in the US and Europe. Methods Between January 1990 and October 2010, clinical data of 60 patients diagnosed with SI- ADH by Classic criterion and registered to Chinese PLA General Hospital were analyzed retrospectively. K test was used to investigate the consistency in diagnosis of SIADH among the Smith, American and European criteria. The area under ROC （AUC-ROC） of these three criteria was compared. Results （ 1 ） Only osmolality showed significant difference among four diagnostic criteria in the aspect of metabolic disturbance （ P 〈 0. 05 ） ; （2） The consis- tency rates were 90% 183.33% and 93.33% ,and K values 0. 58,0. 43 and 0. 8 between European and American, between European and Smith, and between American and Smith criteria, respectively. （3） Using classical cri- teria as reference,the Youden indexes of Europe, America and Smith criteria were 0. 917,0. 817 and 0. 75, and AUC-ROCs were 0. 958,0. 908 and 0. 875, respectively. Conclusion Favorable consistency exists among 4 diagnostic criteria. Using classical criteria as reference, the European criteria appear more valuable in diagnosis of SIADH.