Adang R P, Ambergen A W, Talmon J L, Hasman A, Vismans J F, Stockbrügger R W
Department of Gastroenterology and Hepatology, University Hospital, Maastricht, The Netherlands.
Digestion. 1996;57(2):118-34. doi: 10.1159/000201325.
The discriminative value of patient characteristics and dyspeptic symptoms for upper gastrointestinal endoscopic findings was prospectively assessed in 1,147 patients attending for their first diagnostic endoscopy and who answered paper (n = 431) or computerized (n = 716) questionnaires. The questionnaires provided detailed information concerning present dyspeptic symptoms, with special attention to provoking and/or relieving factors, and smoking and/or drinking habits. In logistic regression models each of a number of 'specific endoscopic diagnoses' was contrasted with normal endoscopy (n = 390), and 'relevant endoscopic disease' (oesophagitis, peptic ulcers, cancers; n = 269) was contrasted with 'irrelevant' and normal endoscopic findings (n = 878). From the regression model a receiver operating characteristic (ROC) curve could be constructed, and the area under the ROC curve (AUC) was calculated to summarize the discriminative power of the regression model. The best discrimination from patients with a normal endoscopy was achieved for patients with gastric (AUC = 0.86) or duodenal (AUC = 0.85) ulcers, followed by patients with hiatus hernia (AUC = 0.78 or oesophagitis (AUC = 0.77). The discriminative performance of the regression models was somewhat less for duodenitis/bulbitis (AUC = 0.75) and endoscopic gastritis (AUC = 0.73). In an open-access endoscopy unit setting, the value of preinvestigation history-taking for the prediction of clinically relevant endoscopic disease was very limited (AUC = 0.63).
前瞻性评估了1147例接受首次诊断性内镜检查并回答纸质问卷（n = 431）或计算机问卷（n = 716）的患者的患者特征和消化不良症状对上消化道内镜检查结果的鉴别价值。问卷提供了有关当前消化不良症状的详细信息，特别关注诱发和/或缓解因素以及吸烟和/或饮酒习惯。在逻辑回归模型中，将多种“特定内镜诊断”分别与正常内镜检查（n = 390）进行对比，将“相关内镜疾病”（食管炎、消化性溃疡、癌症；n = 269）与“无关”和正常内镜检查结果（n = 878）进行对比。根据回归模型可以构建受试者操作特征（ROC）曲线，并计算ROC曲线下面积（AUC）以总结回归模型的鉴别能力。对于患有胃溃疡（AUC = 0.86）或十二指肠溃疡（AUC = 0.85）的患者，与正常内镜检查患者的鉴别效果最佳，其次是患有食管裂孔疝（AUC = 0.78）或食管炎（AUC = 0.77）的患者。对于十二指肠炎/球炎（AUC = 0.75）和内镜性胃炎（AUC = 0.73），回归模型的鉴别性能略低。在开放式内镜检查单位环境中，检查前病史采集对预测临床相关内镜疾病的价值非常有限（AUC = 0.63）。
