摘要
目的评价标准皮试用变应原皮肤点刺试验(skin prick test,SPT)、血清总IgE(TIgE)测定及嗜酸性粒细胞计数(eosinophil count,EOS)在儿童哮喘临床诊断中的价值。方法收集2007-2010年在本院儿科门诊及住院部就诊怀疑哮喘的所有儿童,选取均检测SPT、TIgE、外周血EOS水平和肺功能的患儿549例,以临床标准(临床症状和肺功能)作为金标准最终确诊358例为哮喘(包括咳嗽变异型哮喘),191例为其他疾病,包括上呼吸道感染、肺炎、湿疹、荨麻疹、慢性咳嗽(非咳嗽变异性哮喘)、过敏性鼻炎、结核等。作出受试者工作特征曲线(ROC曲线),确定诊断截断点(cut off points)TIgE为88 IU/ml,EOS为288×106个/L。结果应用非参数法估计儿童哮喘的3种检验方法曲线下面积:EOS为0.699(95%CI0.655～0.744),TIgE为0.827(95%CI0.793～0.862),SPT为0.806(95%CI0.766～0.847)。检验的灵敏度、特异度、正确率、阳性预测值、阴性预测值,TIgE分别是85.5%、64.7%、77.2%、77.9%、75.9%;SPT分别是87.5%、71.8%、81.6%、83.8%、77.5%;而EOS分别是77.5%、46.8%、61.9%、58.7%、68.1%;TIgE+SPT平行试验分别是81.4%、75.2%、79.6%、89.1%、61.8%;TIgE+SPT系列试验分别是94.2%、64.1%、79.2%、72.6%、91.6%。结论 TIgE与SPT的灵敏度、特异度、正确率、阳性预测值、阴性预测值相似,且均优于EOS,无论是平行试验还是系列试验,TIgE+SPT的组合均优于各组中的其他组合,TIgE+SPT的联合试验对变应性哮喘的诊断意义较大。
Objective To evaluate the diagnostic value the skin prick test（SPT）,serum total IgE and eosinophil count（EOS） in children with asthma.Methods A total of 549 children who were suspected to have asthma were subjected from March 2007 and June 2010.They were examined with SPT,serum total IgE test and eosinophil count（EOS）.Using the clinical symptoms and pulmonary function tests as the Golden standard,358 cases had been diagnosed to suffer from asthma,and the other 191 cases had respiratory tract infection,pneumonia,eczema,hives,chronic cough（not cough variant asthma）,allergic rhinitis,bronchi,tuberculosis and so on.Sensitivity,specificity,and accuracy of SPT,total IgE and EOS were compared by using receiver operator characteristic curve（ROC） analysis,and the cut off points of total IgE and EOS was 88 IU/ml and 288×106/L.Results By non-parametric methods,the areas under ROC curves of SPT,total IgE and EOS were 0.806（95%CI 0.766 to 0.847）,0.827（95%CI 0.793 to 0.862） and 0.699（95%CI 0.655 to 0.744） respectively in the childhood asthma diagnostic tests.The sensitivity,specificity,accuracy,positive and negative predictive values for the diagnosis of children asthma by total IgE were 85.5%,64.7%,77.2%,77.9% and 75.9% respectively,those by SPT,were 87.5%,71.8%,81.6%,83.8% and 77.5%,respectively,and those by EOS were 77.5%,46.8%,61.9%,58.7% and 68.1% respectively,those by parallel tests of total IgE and SPT were 81.4%,75.2%,79.6%,89.1% and 61.8% respectively,and those by serial test of total IgE and SPT were 94.2%,64.1%,79.2%,72.6% and 91.6% respectively.Conclusion The sensitivity,specificity,accuracy,positive and negative predictive value of total IgE is closely related to SPT and preferably to EOS.Both parallel tests and serial tests of total IgE and SPT are better than the other methods in our study.The combined detection of total IgE and SPT is one of very valuable methods in the diagnosis of childhood asthma.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2011年第7期682-685,共4页
Journal of Third Military Medical University
基金
国家自然科学基金面上项目(30600686)
重庆市自然科学基金(CSTC2007BB5062)~~
关键词
皮肤点刺试验
总IGE
嗜酸性粒细胞计数
儿童哮喘
ROC
诊断试验
skin prick test
total IgE
eosinophil count
childhood asthma
receiver operator characteristic curve
diagnostic test
