哮喘患病率的贝叶斯估计，以及在缺乏金标准的情况下运动诊断与问卷调查诊断的比较。

Bayesian estimation of asthma prevalence, and comparison of exercise and questionnaire diagnostics in the absence of a gold standard.

作者信息

Demissie K, White N, Joseph L, Ernst P

机构信息

Respiratory Epidemiology Unit, McGill University, Montreal, Quebec, Canada.

出版信息

Ann Epidemiol. 1998 Apr;8(3):201-8. doi: 10.1016/s1047-2797(97)00168-3.

DOI:10.1016/s1047-2797(97)00168-3

PMID:9549006

Abstract

PURPOSE

To estimate the sensitivities, specificities, and predictive values of exercise challenge and questionnaire, when these tests are used to diagnose asthma in children.

METHODS

Participants were children, predominantly aged 6 to 12 years, selected from three primary school grades among 18 different schools in Montreal. Of 1111 participants, 989 successfully completed a six-minute free running test at school and returned a respiratory questionnaire. A total of 952 children had complete information that could be used for analysis. A history of wheezing in the past year in conjunction with a past diagnosis of asthma defined current asthma by questionnaire. Exercise responsiveness was defined as a > or = 10% fall in FEV1 after a six-minute free run. As there is no perfectly accurate diagnostic test for asthma, we analyzed the data using a previously published Bayesian method that allows for the estimation of test properties when no gold standard test is available.

RESULTS

Current asthma by questionnaire was found to have significantly higher specificity (94.9%, 95% credible interval (CI): 93.2-96.5 versus 82.6%, 95% CI: 79.9-85.1) and positive predictive value (53.8%, 95% CI: 41.0-66.7 versus 19.2%, 95% CI: 12.3-27.8) in comparison to exercise challenge. While there was no statistically significant difference between the two tests with respect to sensitivity and negative predictive values, the estimates were higher for current asthma (64.4%, 95% CI: 50.9-76.6 and 96.7%, 95% CI: 94.6-98.1, respectively) in comparison to exercise challenge (51.3%, 95% CI: 37.8-64.5 and 95.4%, 95% CI: 93.2-97.1, respectively). Agreement between the two diagnostic methods was poor and the combined use of the two tests did not significantly improve the likelihood of correctly identifying children with asthma.

CONCLUSIONS

Our findings support the view that exercise testing adds little to a well designed questionnaire in identifying subjects with asthma in community based studies.

摘要

目的

评估运动激发试验和问卷调查在诊断儿童哮喘时的敏感性、特异性及预测值。

方法

研究对象为儿童，主要年龄在6至12岁，从蒙特利尔18所不同学校的三个小学年级中选取。1111名参与者中，989名在学校成功完成了六分钟自由跑步测试并返回了呼吸问卷。共有952名儿童拥有可用于分析的完整信息。问卷中，过去一年的喘息史以及过去诊断的哮喘定义为当前哮喘。运动反应性定义为六分钟自由跑步后第一秒用力呼气量（FEV1）下降≥10%。由于没有针对哮喘的完全准确的诊断测试，我们使用先前发表的贝叶斯方法分析数据，该方法可在没有金标准测试时估计测试特性。

结果

与运动激发试验相比，问卷诊断当前哮喘的特异性（94.9%，95%可信区间（CI）：93.2 - 96.5，而运动激发试验为82.6%，95% CI：79.9 - 85.1）和阳性预测值（53.8%，95% CI：41.0 - 66.7，而运动激发试验为19.2%，95% CI：12.3 - 27.8）显著更高。虽然两种测试在敏感性和阴性预测值方面无统计学显著差异，但与运动激发试验相比，当前哮喘的估计值更高（分别为64.4%，95% CI：50.9 - 76.6和96.7%，95% CI：94.6 - 98.1，运动激发试验分别为51.3%，95% CI：37.8 - 64.5和95.4%，95% CI：93.2 - 97.1）。两种诊断方法之间的一致性较差，两种测试联合使用并未显著提高正确识别哮喘儿童的可能性。