脊柱结核GATA、SMU分型的可信度及可重复性对比分析

Comparison of inter-and intra-observer reliability between GATA and SMU classification systems for spinal tuberculosis

目的对比脊柱结核GATA、SMU分型的可信度及可重复性,探讨SMU分型的临床应用价值。方法随机选取佛山市中医院于2004年1月~2011年12月期间收治的100例脊柱结核患者资料,男54例,女46例;年龄16~68岁,平均45岁。每例均有完整的X线、MRI及CT资料。由5名经验丰富的医师分别进行脊柱结核两种分型,对分型类别的一致性进行分析,计算Kappa值检验可信度,3个月后再次分型,对分型的可重复性进行分析,计算Kappa值检验可重复性。结果 GATA分型可信度平均为（59.9±4.84）%,Kappa值0.412±0.058,可重复性平均为（75.6±5.27）%,Kappa值0.624±0.078;SMU分型的可信度平均为（81.6±6.06）%,Kappa值0.753±0.068,可重复性平均为（89.8±2.28）%,Kappa值0.862±0.037。结论脊柱结核SMU分型具有较优的可信度及可重复性,对规范临床治疗具有较好的指导意义,但仍需进一步临床验证及完善。

Objective To compare the inter- and intra-observer reliability of the GATA and SMU classification systems for spinal tuberculosis and assess the clinical value of SMU classification. Methods One hundred patients with spinal tuberculosis treated in our hospital from January 2004 to December 2011 were randomly selected for analysis, including 54 males and 46 females with a mean age of 45 years （range, 16- 68 years）. All the patients had X-ray CT and MRI examinations. Five observers experienced in spinal tuberculosis independently assigned the classification using the GATA and SMU classification systems, and the assignment was repeated 3 months later to test its reproducibility. Kappa value was used to determine the intra- and inter-observer reliability. Results For GATA and SMU classification systems, the inter-observer percentage of agreement averaged （59.9±4.84）% （K--0.412±0.058） and （81.6±6.06）% （K=0.753±0.068）, and the intra-observer percentage of agreement was （75.6±5.27）% （K=0.624±0.078） and （89.8±2.28）% （K=0.862±0.037）, respectively. Conclusion The SMU classification system of spinal tuberculosis has a higher inter-observer and intra-observer reliability than the GATA classification system, but its clinical value needs to be further tested in future clinical trials.