Popescu C M, Popescu R, Williams H, Forsea D
Universitatea de Medicină şi Farmacie Carol Davila, Clinica I Dermatologie, Bucureşti, România.
Br J Dermatol. 1998 Mar;138(3):436-42. doi: 10.1046/j.1365-2133.1998.02121.x.
Although the U.K. modification of Hanifin and Rajka's diagnostic criteria for atopic dermatitis (AD) for use in epidemiological studies has demonstrated good validity and repeatability when previously tested in a U.K. community setting, little is known about its performance in other countries where different cultural, educational and linguistic factors could impair validity. We used a questionnaire to test the validity of the U.K. criteria as a point prevalence measure of AD in 1114 Romanian schoolchildren aged 6-12 years against the clinical diagnosis of a dermatologist with an interest in AD, who was unaware of the questionnaire content and responses. The sensitivity and specificity of the U.K. criteria for AD in this setting was 74% and 99%, respectively, an improvement rather than a deterioration in validity when compared with the previous U.K. study. Test-retest repeatability for all of the questions pertaining to the U.K. criteria using the chance-corrected kappa statistic was high, with values of 0.72 and over. The positive predictive value of the criteria was lower than in the U.K. study (63% compared with 80%, respectively) due to the very low prevalence of AD in this study (2.4%). The validity of a parental report of 'eczema' was poor, with a sensitivity of 22%, specificity of 97% and positive predictive value of 18%. This study suggests that the U.K. criteria perform well in settings outside the U.K., although care has to be taken when using the criteria to ascertain cases in settings where the prevalence of AD is very low.
尽管英国对用于流行病学研究的哈尼芬和拉伊卡特应性皮炎（AD）诊断标准进行的修改，在之前英国社区环境测试时已证明具有良好的效度和可重复性，但对于其在其他国家的表现却知之甚少，因为在这些国家，不同的文化、教育和语言因素可能会损害效度。我们使用一份问卷，针对1114名6至12岁罗马尼亚学童，以对AD感兴趣且不知问卷内容及答案的皮肤科医生的临床诊断为对照，来测试英国标准作为AD现患率测量方法的效度。在此环境下，英国AD标准的敏感性和特异性分别为74%和99%，与之前英国的研究相比，效度有所提高而非降低。使用机会校正卡方统计量对所有与英国标准相关问题进行重测的可重复性很高，值在0.72及以上。由于本研究中AD患病率极低（2.4%），该标准的阳性预测值低于英国的研究（分别为63%和80%）。家长报告的“湿疹”效度较差，敏感性为22%，特异性为97%，阳性预测值为18%。本研究表明，英国标准在英国以外的环境中表现良好，不过在AD患病率极低的环境中使用该标准确定病例时需谨慎。
