COMISS认知工具在诊断婴幼儿牛奶蛋白过敏的实验性研究

Experimental study of COMISS cognitive tools in the diagnosis of milk protein allergy in infants and young children

目的 探讨COMISS认知工具在中国诊断婴幼儿牛奶蛋白过敏的作用,并研究COMISS工具是否可以替代目前诊断CMPA所做的食物激发试验。方法 回顾性收集了本院2017年3月至2017年11月疑似牛奶蛋白过敏婴幼儿60例,医务人员对每位患者进行COMISS评估,并要求婴儿完全吃完全水解蛋白奶粉,之后进行第2次COMISS评估和食物激发实验,并以食物激发实验作为金标准,对COMISS认知工具的真实性、可靠性、收益等进行评价,并绘制ROC曲线,确定最佳截断值。结果 COMISS评估方法的灵敏度为18.18%;假阴性率为81.82%;特异度为83.33%;假阳性率为16.67%;粗一致性为26.00%;收益评价:约登指数为1.51%;阳性预测值为88.89%;阴性预测值为12.19%;阳性似然比为1.09;阴性似然比为0.938。ROC曲线下面积(AUC)为0.148,面积的标准误为0.012,95%置信区间为(0.132~0.161),最佳截点5.8,灵敏度、特异度分别为28.5%、89.6%。结论 COMISS评估可作为诊断婴幼儿牛奶蛋白过敏的辅助方法,虽然评估起来简便易测、便于接受,但灵敏度较低,尚不能在我国婴幼儿牛奶蛋白过敏中发挥较大的诊断价值。

Objective To explore the role of COMISS cognitive tools in the diagnosis of infant milk protein allergy in China,and to study whether the COMISS tool can replace the food challenge test currently diagnosed by CMPA.Methods A retrospective collection of 60 infants with suspected milk protein allergy in our hospital,medical staff conducted a COMISS assessment on each infant,and required the infants to completely consume fully hydrolyzed protein milk powder,followed by the second COMISS assessment and the food provocation test,and with the food provocation test as the gold standard,the authenticity,reliability,and benefit of the COMISS cognitive tool were evaluated,and the ROC curve was drawn to determine the optimal cutoff value.Results The sensitivity of the COMISS evaluation method was 18.18%;the false negative rate was 81.82%;the specificity was 83.33%;the false positive rate was 16.67%;the coarse consistency was 26.00%;the benefit evaluation:the Yoden index was 1.51%;the positive predictive value was 88.89%;the negative predictive value was 12.19%;the positive likelihood ratio was 1.09;the negative likelihood ratio was 0.938.The area under the ROC curve(AUC)was 0.148,the standard error of the area was 0.012,the 95%confidence interval was(0.132~0.161),the optimal cut point was 5.8,and the sensitivity and specificity were 28.5%and 89.6%,respectively.Conclusions The COMISS evaluation can be used as an auxiliary method for diagnosing milk protein allergy in infants and young children.Although it is easy to measure and easy to accept,it has low sensitivity and can not play a large diagnostic value in infant milk protein allergy.