舌下静脉曲张相对面积评分的可靠性测量：一项诊断研究。
The relative area score for sublingual varices reliability measurement: a diagnostic study.
机构信息
Department of Prosthetic Dentistry, Preclinical Education and Materials Science, Dental School, Rheinische Friedrich-Wilhelms University, University of Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany.
Department of Oral, Maxillofacial and Plastic Surgery, Center of Dento-Maxillo-Facial Medicine, University Hospital Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany.
出版信息
BMC Oral Health. 2023 Jun 6;23(1):366. doi: 10.1186/s12903-023-03068-x.
BACKGROUND
Sublingual varices (SV) and their predictive potential for other clinical parameters is a much studied topic in oral medicine. SVs have been well studied as predictive markers for many common diseases such as arterial hypertension, cardiovascular disease, smoking, type 2 diabetes mellitus and age. Despite many prevalence studies, it is still unclear how the reliability of SV inspection affects its predictive power. The aim of this study was to quantify the inspection reliability of SV.
METHODS
In a diagnostic study, the clinical inspection of 78 patients by 23 clinicians was examined for the diagnosis of SV. Digital images of the underside of the tongue were taken from each patient. The physicians were then asked to rate them for the presence of sublingual varices (0/1) in an online inspection experiment. Statistical analysis for inter-item and inter-rater reliability was performed in a τ-equivalent measurement model with Cronbach's [Formula: see text] and Fleiss κ.
RESULTS
The interrater reliability for sublingual varices was relatively low with κ = 0.397. The internal consistency of image findings for SV was relatively high with α≈ 0.937. This shows that although SV inspection is possible in principle, it has a low reliability R. This means that the inspection finding (0/1) of individual images often cannot be reproduced stably. Therefore, SV inspection is a difficult task of clinical investigation. The reliability R of SV inspection also limits the maximum linear correlation [Formula: see text] of SV with an arbitrary other parameter Y. The reliability of SV inspection R = 0.847 limits the maximum correlation to [Formula: see text] (SV, Y) = 0,920-a 100% correlation was a priori not achievable in our sample. To overcome the problem of low reliability in SV inspection, we propose the RA (relative area) score as a continuous classification system for SV, which normalises the area of visible sublingual veins to the square of the length of the tongue, providing a dimensionless measure of SV.
CONCLUSIONS
The reliability of the SV inspection is relatively low. This limits the maximum possible correlation of SV with other (clinical) parameters. SV inspection reliability is an important indicator for the quality of SV as a predictive marker. This should be taken into account when interpreting previous studies on SV and has implications for future studies. The RA score could help to objectify the SV examination and thus increase its reliability.
背景
舌下静脉曲张（SV）及其对其他临床参数的预测潜力是口腔医学领域的一个研究热点。SV 已经被很好地研究作为许多常见疾病的预测标志物，如动脉高血压、心血管疾病、吸烟、2 型糖尿病和年龄。尽管有许多流行性病学研究，但仍不清楚 SV 检查的可靠性如何影响其预测能力。本研究的目的是量化 SV 检查的可靠性。
方法
在一项诊断研究中，由 23 名临床医生对 78 名患者进行了 SV 临床检查。从每位患者的舌底拍摄了数字图像。然后，医生们在一个在线检查实验中被要求对舌下静脉曲张（0/1）的存在进行评分。采用τ等效测量模型进行项目间和评价者间可靠性的统计分析，使用 Cronbach's [Formula: see text]和 Fleiss κ。
结果
舌下静脉曲张的评价者间可靠性相对较低，κ=0.397。SV 图像发现的内部一致性相对较高，α≈0.937。这表明，尽管原则上可以进行 SV 检查，但它的可靠性 R 较低。这意味着个别图像的检查结果（0/1）通常不能稳定再现。因此，SV 检查是一项困难的临床研究任务。SV 检查的可靠性 R 也限制了 SV 与任意其他参数 Y 的最大线性相关性 [Formula: see text]。在我们的样本中，SV 检查的可靠性 R=0.847 限制了最大相关性为 [Formula: see text]（SV，Y）=0.920-一个 100%的相关性在我们的样本中是不可能达到的。为了解决 SV 检查可靠性低的问题，我们提出了 RA（相对面积）评分作为 SV 的连续分类系统，该系统将可见舌下静脉的面积归一化为舌长的平方，提供了 SV 的无量纲测量。
结论
SV 检查的可靠性相对较低。这限制了 SV 与其他（临床）参数的最大可能相关性。SV 检查的可靠性是 SV 作为预测标志物的质量的一个重要指标。在解释以前关于 SV 的研究时应考虑这一点，并对未来的研究有影响。RA 评分可以帮助客观化 SV 检查，从而提高其可靠性。
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