关于《大骨节病诊断》标准中X线影像下指骨骨骺等径期前的限定是否应扩展为超径期前的探讨

Whether the limitation of the phalangeal epiphysis"before the equal-diameter period"should be extended to"before the ultra-diameter period"in X-ray diagnosis of Kashin-Beck disease

目的探讨现行《大骨节病诊断》标准(WS/T 207-2010)中儿童大骨节病诊断时"等径期前"这一限定是否合理,同时为《大骨节病诊断》标准(WS/T 207-2010)的修订提供基础数据和技术支撑。方法2018年选择黑龙江省大骨节病历史病区作为调查点,拍摄调查点全部7~12岁儿童的右手X线正位片,根据其指骨骨骺生长发育过程中不同的X线表现划分为等径期前、等径期、超径期、闭合前期和闭合期5个时期。按年龄、性别等基础资料分层,比较各期干骺-骨骺闭合反应检出率;以1990年全国大骨节病病情监测中黑龙江省林口县和富裕县监测点干骺端改变检出率的均值为依据,推算并比较在等径期前、超径期前的限定下或缩减受检儿童年龄范围,受检儿童中大骨节病干骺端改变的预期检出率和漏诊率。结果共调查5019名儿童,等径期前儿童所占比例为53.94%(2707/5019),超径期前儿童所占比例为77.92%(3911/5019)。等径期前主要出现在7~10岁,并随年龄增长呈减少趋势(χ^(2)_(趋势)=390.10,P<0.05);超径期主要出现在10~12岁,随年龄增长呈减少趋势(χ^(2)_(趋势)=65.39,P<0.05);闭合前期主要出现在10~12岁,随年龄增长呈增加趋势(χ^(2)_(趋势)=51.86,P<0.05);闭合期主要出现在11~12岁,随年龄增长呈增加趋势(χ^(2)_(趋势)=7.58,P<0.05)。超径期儿童的干骺-骨骺闭合反应检出率为14.78%(158/1069),而等径期儿童中并未检出现干骺-骨骺闭合反应。在等径期前、超径期前和7~10岁受检儿童中,干骺端改变预期检出率分别为5.90%、8.53%和7.42%,预期漏诊率分别为5.06%、2.45%和3.52%。结论为提高干骺端改变检出率,降低漏诊率,在儿童大骨节病的X线诊断和病情监测中,应将"等径期"的儿童纳入诊断。

Objective To explore whether the limit of"before the equal-diameter period"is reasonable in the current criteria for"Diagnosis of Kashin-Beck Disease"(WS/T 207-2010)in children,and to provide basic data and technical support for revision of the criteria for"Diagnosis of Kashin-Beck Disease"(WS/T 207-2010).Methods In 2018,the historical Kashin-Beck disease(KBD)areas in Heilongjiang Province were selected as the investigation sites.The right-hand X-ray films of all children aged 7-12 years old were taken.According to the different X-ray manifestations of the growth and development of the phalangeal epiphysis,they were divided into five periods:before the equal-diameter period,equal-diameter period,ultra-diameter period,pre-closure period and closure period.Firstly,after stratifying by basic data such as age and gender,the data were standardized and analyzed.Secondly,the detection rates of metaphysis-epiphysis(CRME)in each period were calculated and compared.Finally,based on the mean value of the detection rate of metaphyseal change in Linkou and Fuyu counties of Heilongjiang Province in 1990,the rates of expected detection and missed diagnosis of metaphyseal changes of KBD among investigated children were calculated and compared under the limitation of before the equal-diameter period,before the ultra-diameter period or age range reduction.Results A total of 5019 children were investigated.The proportion of children before the equal-diameter period was 53.94%(2707/5019),and that of before the ultra-diameter period was 77.92%(3911/5019).The results showed that the equal-diameter period mainly appeared in 7-10 years old,and showed a decreasing trend with the increase of age(χ^(2)_(trend)=390.10,P<0.05);the ultra-diameter period mainly occurred in 10-12 years old,showing a decreasing trend with the increase of age(χ^(2)_(trend)=65.39,P<0.05);the pre-closure period mainly occurred in 10-12 years old,with an increasing trend with the increase of age(χ^(2)_(trend)=51.86,P<0.05);the closure period mainly occurred in 11-12 years old and increased with age(χ^(2)_(trend)=7.58,P<0.05).The CRME of children in ultra-diameter period was 14.78%(158/1069),however CRME did not occur in children with equal-diameter period.Among children before equal-diameter period,before ultar-diameter period and aged 7-10 years old,the expected detection rates of metaphyseal changes of KBD were 5.90%,8.53%and 7.42%,respectively.The expected missed diagnosis rates of metaphyseal changes of KBD were 5.06%,2.45%and 3.52%,respectively.Conclusion In order to improve the rate of expected detection and lower the rate of missed diagnosis of metaphyseal changes of KBD,children in"equal-diameter period"should be included in X-ray diagnosis and disease monitoring of KBD.