6岁以下儿童哮喘诊断标准验证的多中心研究

Multi-center study on the verification of diagnosis criteria for asthma in children under 6 years of age

目的建立客观、稳定的6岁以下儿童哮喘诊断标准。方法2020年9月至12月,共22个医疗中心纳入2263例6岁以下有喘息史的患儿相关信息,设计标准化病历系统,建立数据库。将喘息患儿根据现有诊断标准分为哮喘组1151例和非哮喘组1112例,并以"33111评分法"重新诊断,检测其对哮喘组和非哮喘组诊断的特异度、敏感度。结果哮喘组患儿依据"33111评分法"仍诊断为哮喘者1068例,未诊断哮喘者83例;非哮喘组患儿依据"33111评分法"仍未诊断哮喘者950例,诊断为哮喘者162例。以现有诊断方法为依据,"33111评分法"诊断的ROC曲线下面积为0.934,95%可信区间(0.924,0.934),灵敏度为0.928,特异度为0.854。阳性预测值86.80%,阴性预测值92.00%,阳性似然比6.36,阴性似然比0.084,Youden指数0.752。结论经多中心大样本验证,"33111评分法"稳定性较强,指标客观,可操作性强,具有较高临床应用价值。

Objective To establish objective and stable diagnostic criteria for asthma in children under the age of 6.Methods In total of 22 medical centers,2263 children with less than 6 years of age with a wheezing history were included in the related information from September to December 2020.A standardized medical record system was designed,and a database was established.Wheezing children were divided into 1151 asthma and 1112 non-asthma groups according to the existing diagnostic criteria and rediagnosed with“33111 scoring system”to test for their specificity and sensitivity to the two groups.Results In the asthma group,1068 children were still diagnosed with asthma according to the“33111 scoring system”,while 83 cases were not diagnosed as asthma.In the non-asthmatic group,950 children were still undiagnosed with asthma and 162 children were diagnosed with asthma according to“33111 score”Among the wheezing children diagnosed as non-asthma according to the existing guidelines,950 cases were also diagnosed as non-asthma according to the“33111 scoring system”,while 162 cases were diagnosed as asthma.Compared with the existing guidelines,the area under the ROC curve of the“33111 scoring system”was 0.934,with a 95%confidence interval(0.924,0.934).The positive predictive value was 86.80%.The negative predictive value was 92.00%.The positive likelihood ratio was 6.36.The negative likelihood ratio was 0.084.The Youden index was 0.752.Conclusion The“33111 scoring system”has been proved to have strong stability and high operability through multi-center and large sample verification,indicating it has high clinical value.