Marks R, Barton S P, Shuttleworth D, Finlay A Y
Department of Medicine (Dermatology), University of Wales College of Medicine, Heath Park, Cardiff.
Arch Dermatol. 1989 Feb;125(2):235-40.
Effective methods of recording and measuring progress of the signs of psoriasis are essential and central to the accurate assessment of therapy. Currently there is wide variation in assessment methods used, and even well-designed clinical assessment techniques have a wide observer error: objective assessment methods may have advantages. The clinical assessment techniques used in 30 clinical trials of treatment in chronic plaque psoriasis in 1985 and 1986 were reviewed and a detailed analysis is presented. In only 18 trials were individual regions assessed, and widely differing methods of scoring signs were used. Reproducibility of the assessment by clinicians of area of skin involvement by psoriasis was studied. Ten patients with chronic plaque psoriasis had standardized photography, and four clinicians assessed area of involvement from the photographs. The clinicians significantly differed in their rank ordering of the area of psoriatic skin involvement. Area of involvement by psoriasis in the same photographs was assessed objectively using computer-assisted planimetry. Although the clinicians' assessment did not differ randomly from the objective measurement, the accuracy of subjective area assessment is not the same for all clinicians. As even experienced clinical observers show wide variation when attempting to record clinical severity of psoriasis, there is clearly a need for better objective measures of psoriasis severity.
记录和测量银屑病体征进展的有效方法对于准确评估治疗至关重要且是核心所在。目前所使用的评估方法差异很大，即便设计良好的临床评估技术也存在较大的观察者误差：客观评估方法可能具有优势。对1985年和1986年进行的30项慢性斑块状银屑病治疗临床试验中所使用的临床评估技术进行了回顾，并给出了详细分析。仅有18项试验对各个区域进行了评估，且使用了差异很大的体征评分方法。对临床医生评估银屑病累及皮肤面积的可重复性进行了研究。10例慢性斑块状银屑病患者进行了标准化摄影，4名临床医生根据照片评估累及面积。临床医生对银屑病累及皮肤面积的排序存在显著差异。使用计算机辅助平面测量法对同一张照片中银屑病的累及面积进行客观评估。尽管临床医生的评估与客观测量并非随机不同，但主观面积评估的准确性对所有临床医生而言并不相同。由于即使是经验丰富的临床观察者在试图记录银屑病的临床严重程度时也存在很大差异，显然需要更好的银屑病严重程度客观测量方法。
