广西少数民族地区不同文化程度人群国际HIV相关性痴呆量表诊断界值的探索性研究

An exploratory study on the diagnostic cutoff value of International HIV-associated Dementia Scale in minority ethnic groups with different educational levels, in Guangxi

目的以简易智能量表（MMSE）为金标准，确定国际HIV相关性痴呆量表（IHDS）在广西少数民族地区不同文化程度人群中的诊断界值，并评价IHDS在相应界值下的真实性和可靠性。方法从广西少数民族地区筛选出血清阳性的HIV感染者200例，对每名感染者采用随机、同期、盲法测试MMSE和IHDS；以MMSE测试结果为金标准，通过ROC曲线确定IHDS在少数民族地区不同文化程度人群中的HIV相关性痴呆诊断界值，并评价特定界值下IHDS的灵敏度、特异度及内部一致性系数。结果当不考虑感染者的文化程度差异时，少数民族地区人群的IHDS诊断界值为8．25，此时IHDS的灵敏度为0．925、特异度为0．731、Kappa为0．477（P〈0．001）。当考虑感染者的文化程度差异时，不同文化程度人群的IHDS诊断界值有所不同：中学或以上文化人群的IHDS诊断界值为8．25，此时灵敏度为0．917、特异度为0．895、Kappa为0．722（P〈0．001）；小学文化人群的IHDS诊断界值为7．25，灵敏度为0．875、特异度为0．661、Kappa为0．372（P〈0．001）。结论广西少数民族地区人群的IHDS诊断界值低于国际推荐的诊断界值水平（IHDs≤10分）；在该地区运用IHDS筛查HIV相关性痴呆时，应根据当地HIV感染者的文化程度差异制订出适用于不同文化层次HIV感染者的IHDS诊断界值。

Objective Using Intelligence Scale of Mini Mental State Estimated （MMSE） as the gold standard to determine the relevance of International HIV-associated Dementia Scale （IHDS）in minority ethnic areas in Guangxi populations with different cultural values. Corresponding boundary value related to the authenticity and reliability on IHDS were also evaluated. Methods 200 patients with HIV infection were randomly selected from the minority ethnic groups in Guangxi. For each infected person, MMSE and IHDS blind scale were tested at the same period. Using the results from MMSE scale test as the gold standard, ROC curve and IHDS scale in Guangxi minority populations with different education levels which related to the diagnosis of dementia-HIV values were determined. The value of a specific sector under the IHDS sensitivity, specificity, and internal consistency coefficients was also evaluated. Results When considering the infected person did not differ on their educational level, the IHDS scale diagnostic cutoff appeared as 8.25, while IHDS sensitivity as 0.925, specificity as 0.731 and Kappa as 0.477 （P〈0.001）. When considering the extent of cultural differences did influence the prevalence of infection, the different education groups showed different IHDS diagnostic cutoff values. People with high school, secondary school or higher education levels, the IHDS diagnosis appeared to be 8.25, when sensitivity was 0.917, specificity was 0.895 and Kappa was 0.722 （P〈0.001）. People with only primary education level, the IHDS appeared to be 7.25. When sensitivity was 0.875, specificity was 0.661 and Kappa was 0.372 （P〈0.001）. Conclusion The IHDS diagnostic sector in Guangxi minority groups was lower than the internationally recommended level of diagnostic cutoff value （IHDS〈~10 points）. When using IHDS to perform the HIV related dementia screening program, in the minority areas of Guangxi, culture context, the degree and difference of HIV infection should be considered, especially in using IHDS diagnostic cutoff values.