摘要
目的探讨膝关节、肘关节、腰椎常见临床症状和体征在地方性氟骨症临床诊断中的价值。方法2020年8-10月,在甘肃省饮水型地方性氟中毒重病区高台县的8个行政村和皋兰县的5个行政村开展氟骨症病情横断面调查。以病区村内年龄≥25岁、居住时间>1年且有运动系统症状和体征者作为调查对象,依据《地方性氟骨症诊断标准》(WS/T 192-2021)中的X线诊断条目分为氟骨症组和非氟骨症组。采集两组人群基本信息,并进行骨科查体和数字X线摄影(DR)拍片,采用多因素logistic回归模型拟合膝关节、肘关节、腰椎相关症状和体征对氟骨症诊断的影响。通过绘制受试者工作特征(ROC)曲线评估模型对氟骨症的预测效能,同时应用Kappa检验评价模型与X线诊断(氟骨症诊断金标准)的一致性。结果共纳入调查对象970人,其中氟骨症组501人、非氟骨症组469人。多因素logistic回归分析显示,肘关节屈伸活动范围(ROM)减少≥45°[比值比(OR)=2.73,95%置信区间(CI):2.00~3.72]、肘关节旋转ROM减少≥30°(OR=3.34,95%CI:1.96~5.68)、尺神经损伤症状(OR=3.77,95%CI:3.21~4.42)、间歇性跛行(OR=2.72,95%CI:1.48~4.99)、直腿抬高试验阳性(OR=1.69,95%CI:1.09~2.61)对氟骨症的诊断有影响。ROC曲线下面积为0.88,该模型对氟骨症诊断有较好的预测能力。经Kappa检验,Kappa值为0.61,可以认为该模型对氟骨症的预测与X线诊断有较好的一致性。结论肘关节屈伸受限、肘关节旋转受限、尺神经受损、间歇性跛行、直腿抬高试验阳性对氟骨症均有一定的诊断价值,上述体征联合诊断对氟骨症的预测能力较好。
Objective To investigate the value of common clinical symptoms and signs of knee joint,elbow joint and lumbar spine in clinical diagnosis of endemic skeletal fluorosis.Methods From August to October 2020,a cross-sectional survey of skeletal fluorosis was conducted in 8 administrative villages in Gaotai County and 5 administrative villages in Gaolan County,which were serious areas of drinking-water-borne endemic fluorosis in Gansu Province.Individuals aged≥25 years old,residing for more than 1 year,and exhibiting symptoms and signs of the motor system in the affected villages were selected as the survey subjects.According to the X-ray diagnostic criteria in the"Diagnostic Standard for Endemic Skeletal Fluorosis"(WS/T 192-2021),they were divided into skeletal fluorosis group and non skeletal fluorosis group.The basic information of the two groups was collected,and orthopedic examination and digital radiography(DR)were performed.Multivariate logistic regression model was used to fit the effects of knee joint,elbow joint and lumbar spine related symptoms and signs on the diagnosis of skeletal fluorosis.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive effectiveness of the model for skeletal fluorosis,and Kappa test was used to evaluate the consistency between the model and X-ray diagnosis(the gold standard for diagnosis of skeletal fluorosis).Results A total of 970 subjects were included in the investigation,including 501 in the skeletal fluorosis group and 469 in the non skeletal fluorosis group.Multivariate logistic regression analysis showed that elbow joint flexion and extension range of motion(ROM)decreased by≥45°[odds ratio(OR)=2.73,95%confidence interval(CI):2.00-3.72],elbow joint rotation ROM decreased by≥30°(OR=3.34,95%CI:1.96-5.68),ulnar nerve injury symptoms(OR=3.77,95%CI:3.21-4.42),intermittent claudication(OR=2.72,95%CI:1.48-4.99),and positive straight leg elevation test(OR=1.69,95%CI:1.09-2.61)had certain impact on the diagnosis of skeletal fluorosis.The area under the ROC curve was 0.88,and the model had a good predictive ability for the diagnosis of skeletal fluorosis.After Kappa test,the Kappa value was 0.61,which suggested that the prediction of skeletal fluorosis by this model was in good agreement with X-ray diagnosis.Conclusions Elbow joint flexion and extension limitation,elbow joint rotation limitation,ulnar nerve injury,intermittent claudication,and positive straight leg elevation test have certain diagnostic value for skeletal fluorosis.The combined diagnosis of these signs has good predictive ability for skeletal fluorosis.
作者
陈国华
李珍珍
王燕玲
李青林
魏域珍
陈晓燕
Chen Guohua;Li Zhenzhen;Wang Yanling;Li Qinglin;Wei Yuzhen;Chen Xiaoyan(Institute of Endemic Diseases,Gansu Provincial Center for Disease Control and Prevention,Lanzhou 730000,China;Institute of Endemic Diseases,Lanzhou Center for Disease Control and Prevention,Lanzhou 730000,China;Department of Endemic Diseases,Gaolan County Center for Disease Control and Prevention,Lanzhou 730200,China)
出处
《中华地方病学杂志》
CAS
北大核心
2023年第9期748-753,共6页
Chinese Journal of Endemiology
基金
甘肃省中医药管理局科研项目(GZKP-2020-27)
甘肃省卫生行业科研管理项目(GWGL-201029)。
