小儿过敏反应中类胰蛋白酶水平的诊断准确性：一项病例对照研究。
Diagnostic Accuracy of Tryptase Levels for Pediatric Anaphylaxis: A Case-Control Study.
作者信息
Khalaf Roy, Prosty Connor, McCusker Christine, Bretholz Adam, Kaouache Mohammed, Clarke Ann E, Ben-Shoshan Moshe
机构信息
Faculty of Medicine, McGill University, Montreal, Québec, Canada.
Division of Allergy Immunology and Dermatology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada.
出版信息
Int Arch Allergy Immunol. 2025;186(4):311-318. doi: 10.1159/000541883. Epub 2024 Oct 30.
INTRODUCTION
Anaphylaxis is a severe allergic reaction which can be difficult to diagnose. Two strategies evaluating changes in tryptase levels were proposed for diagnosing anaphylaxis. Strategy 1 established a threshold of tryptase levels during reaction exceeding 2 ng/mL + 1.2* (baseline tryptase levels) as a rule for detecting anaphylaxis, while strategy 2 established the ratio of tryptase levels during reaction versus baseline tryptase exceeding a threshold of 1.685. We aimed to compare the diagnostic test accuracy of the two strategies in pediatric anaphylaxis.
METHODS
We conducted a case-control study. Cases consisted of 89 patients with anaphylaxis who had reaction tryptase and subsequent baseline tryptase measured. Controls consisted of 25 patients with chronic urticaria who had two tryptase measurements. Sensitivity and specificity for each of the strategies were computed and compared using McNemar test. The area under the curve (AUC) between the two strategies was compared using the DeLong test.
RESULTS
The sensitivity and specificity for strategy 1 was 53.3% and 95.0%, respectively. For strategy 2, the sensitivity and specificity was 54.4% and 85.0%, respectively. There was no significant difference between both strategies' sensitivity and specificity. The Delong test determined that the AUC was significantly (p < 0.05) higher for strategy 1 (0.69) than strategy 2 (0.64).
CONCLUSION
The Delong test determined that strategy 1 was slightly better in validating anaphylaxis diagnosis than strategy 2. However, both strategies demonstrated a low sensitivity <55%.
INTRODUCTION
Anaphylaxis is a severe allergic reaction which can be difficult to diagnose. Two strategies evaluating changes in tryptase levels were proposed for diagnosing anaphylaxis. Strategy 1 established a threshold of tryptase levels during reaction exceeding 2 ng/mL + 1.2* (baseline tryptase levels) as a rule for detecting anaphylaxis, while strategy 2 established the ratio of tryptase levels during reaction versus baseline tryptase exceeding a threshold of 1.685. We aimed to compare the diagnostic test accuracy of the two strategies in pediatric anaphylaxis.
METHODS
We conducted a case-control study. Cases consisted of 89 patients with anaphylaxis who had reaction tryptase and subsequent baseline tryptase measured. Controls consisted of 25 patients with chronic urticaria who had two tryptase measurements. Sensitivity and specificity for each of the strategies were computed and compared using McNemar test. The area under the curve (AUC) between the two strategies was compared using the DeLong test.
RESULTS
The sensitivity and specificity for strategy 1 was 53.3% and 95.0%, respectively. For strategy 2, the sensitivity and specificity was 54.4% and 85.0%, respectively. There was no significant difference between both strategies' sensitivity and specificity. The Delong test determined that the AUC was significantly (p < 0.05) higher for strategy 1 (0.69) than strategy 2 (0.64).
CONCLUSION
The Delong test determined that strategy 1 was slightly better in validating anaphylaxis diagnosis than strategy 2. However, both strategies demonstrated a low sensitivity <55%.
引言
过敏反应是一种严重的过敏反应，可能难以诊断。提出了两种评估类胰蛋白酶水平变化的策略来诊断过敏反应。策略1设定反应期间类胰蛋白酶水平的阈值超过2 ng/mL + 1.2×（基线类胰蛋白酶水平）作为检测过敏反应的规则，而策略2设定反应期间类胰蛋白酶水平与基线类胰蛋白酶的比值超过阈值1.685。我们旨在比较这两种策略在儿童过敏反应诊断测试中的准确性。
方法
我们进行了一项病例对照研究。病例包括89例有过敏反应的患者，测量了其反应时的类胰蛋白酶水平及随后的基线类胰蛋白酶水平。对照包括25例慢性荨麻疹患者，进行了两次类胰蛋白酶测量。计算每种策略的敏感性和特异性，并使用McNemar检验进行比较。使用DeLong检验比较两种策略之间的曲线下面积（AUC）。
结果
策略1的敏感性和特异性分别为53.3%和95.0%。对于策略2，敏感性和特异性分别为54.4%和85.0%。两种策略的敏感性和特异性之间无显著差异。DeLong检验确定策略1的AUC（0.69）显著高于策略2（0.64）（p < 0.05）。
结论
DeLong检验确定在验证过敏反应诊断方面，策略1略优于策略2。然而，两种策略的敏感性均较低，<55%。
引言
过敏反应是一种严重的过敏反应，可能难以诊断。提出了两种评估类胰蛋白酶水平变化的策略来诊断过敏反应。策略1设定反应期间类胰蛋白酶水平的阈值超过2 ng/mL + 1.2×（基线类胰蛋白酶水平）作为检测过敏反应的规则，而策略2设定反应期间类胰蛋白酶水平与基线类胰蛋白酶的比值超过阈值1.685。我们旨在比较这两种策略在儿童过敏反应诊断测试中的准确性。
方法
我们进行了一项病例对照研究。病例包括89例有过敏反应的患者，测量了其反应时的类胰蛋白酶水平及随后的基线类胰蛋白酶水平。对照包括25例慢性荨麻疹患者，进行了两次类胰蛋白酶测量。计算每种策略的敏感性和特异性，并使用McNemar检验进行比较。使用DeLong检验比较两种策略之间的曲线下面积（AUC）。
结果
策略1的敏感性和特异性分别为53.3%和95.0%。对于策略2，敏感性和特异性分别为54.4%和85.0%。两种策略的敏感性和特异性之间无显著差异。DeLong检验确定策略1的AUC（0.69）显著高于策略2（0.64）（p < 0.05）。
结论
DeLong检验确定在验证过敏反应诊断方面，策略1略优于策略2。然而，两种策略的敏感性均较低，<55%。
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