特应性皮炎诊断标准的评价

摘要/Abstract

摘要： 目的探讨特应性皮炎的诊断标准。方法采用对比研究的方法,对Hanifin-Rajka标准(金标准)、康克非标准和Williams标准进行对比分析。结果与"金标准"相比,在医院人群中,Williams标准在应用中有较高的诊断效率,其敏感性、特异性和Kappa值分别为95.50%、97.52%和0.93;且该标准中"2岁前发病"这一指标适用于任何年龄。在一般人群使用中,该标准的敏感性、特异性和Kappa值分别为80.00%、99.78%和0.79,完全适用于7～18岁年龄段人群时点患病率的流行病学调查。此外,瘙痒加以下4条指标中的2条或2条以上:即①屈侧曾有皮炎史,②哮喘和(或)过敏性鼻炎史,③皮肤干燥史,④2岁前发病,这一问卷调查方法,在使用中具有较高的敏感性(88.89%)、特异性(99.78%)和Kappa值(0.82),因此,在特应性皮炎流行病学研究中完全可以取代传统的问卷形式。结论 Williams关于AD的诊断标准完全适用于我国医院人群的临床诊断和小样本人群的流行病学调查。在大样本普查中亦可使用改良的Williams标准。

关键词: 皮炎,特应性, 诊断

Abstract: Objective To evaluate the diagnostic criteria of atopic dermatitis(AD). Methods The Hanifin and Rajka's criteria (gold standard), Williams'and Kang's criteria were compared by controlled investigation. Results The Williams' criteria showed the higher diagnostic efficiency in outpatient settings in comparison with the "gold standard", the sensitivity, specificity and Kappa value reaching 95.50%,97.52% and 0.93, respectively. The index" onset under the age of 2" in Williams'criteria could be applicable in any agegroup. In the population-based investigation, the sensitivity, specificity and Kappa value of Williams'criteria were 80.00%, 99.78% and 0.79, respectively. The criteria were suitable for point prevalence survey of the group aged 7～18 years. It was shown that an improved questionnaire based investigation had higher sensitivity(88.89%), specificity(99.78%) and Kappa value (0.82). The questionnaire consisted of pruritus plus two or more of the following four indexes:① the history of involvement of the skin creases;② a personal history of asthma or hay fever;③ a history of a dry skin;④ onset under the age of 2. Therefore, it could replace the conventional questionnaire for survey of the disease. Conclusions The Williams' criteria are suitable for clinical diagnosis in outpatient settings and epidemiological survey in populations with small sample size in our country. The modified criteria with questionnaire could also be used for mass survey of large sample.

Key words: Dermatitis,atopic, Diagnosis

顾恒, 陈祥生, 陈崑, 颜艳, 金泓, 陈秀琴, 曹宁校, 邵长庚, 叶干运. 特应性皮炎诊断标准的评价[J]. 中华皮肤科杂志, 2000, 33(4): 222-226.doi:

GU Heng, CHEN Xiangsheng, CHEN Kun. Evaluation of Diagnostic Criteria for Atopic Dermatitis[J]. Chinese Journal of Dermatology, 2000, 33(4): 222-226.doi:

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