Nardone D A, Roth K M, Mazur D J, McAfee J H
Ambulatory Care Services, Veterans Administration Medical Center, Portland, OR 97207.
Arch Intern Med. 1990 Jan;150(1):201-4.
Previous studies addressing the usefulness of pallor in anemia are deficient because of observer or spectrum bias. Three internists made individual assessments of conjunctivae, face, nails, palms, and palmar creases in 98 male and 5 female hospitalized patients at a Veterans Administration Medical Center. The true-positive rates (sensitivities) were highest for pallor at any one of three sites (ie, the conjunctivae, face, or palms; 0.65) and for pallor of the palms (0.53). True-negative rates (specificities) were best for palmar creases (1.00), for pallor at conjunctivae, face, and palms (all three in combination; 0.95), and for the face (0.90). Receiver operator characteristic curve analysis revealed that the examination of the nailbeds is inferior to all other sites or combinations. Interobserver variability K scores were negative for palmar creases but ranged from .16 to .51 for other sites. We conclude that (1) the absence of pallor does not rule out anemia, and therefore this sign is not useful for screening an asymptomatic population; (2) pallor of the conjunctivae, face, and palms together is of benefit in confirming the presence of anemia; and (3) neither the nailbeds nor palmar creases are of value in assessing the presence or absence of anemia.
以往关于贫血时面色苍白有用性的研究存在缺陷，原因是存在观察者或范围偏倚。三名内科医生对一家退伍军人管理局医疗中心的98名男性和5名女性住院患者的结膜、面部、指甲、手掌和掌纹进行了个体评估。三个部位（即结膜、面部或手掌）中任何一处出现面色苍白时的真阳性率（敏感度）最高（0.65），手掌苍白的真阳性率为0.53。掌纹的真阴性率（特异度）最佳（1.00），结膜、面部和手掌均出现苍白时（三者联合；0.95）以及面部苍白时（0.90）的真阴性率也较高。受试者工作特征曲线分析显示，甲床检查不如所有其他部位或联合检查。观察者间变异的K值，掌纹为阴性，其他部位则在0.16至0.51之间。我们得出结论：（1）无面色苍白不能排除贫血，因此该体征对筛查无症状人群无用；（2）结膜、面部和手掌均出现苍白有助于确诊贫血；（3）甲床和掌纹在评估有无贫血方面均无价值。
