Kozel M M, Mekkes J R, Bossuyt P M, Bos J D
Department of Dermatology, University of Amsterdam, The Netherlands.
Arch Dermatol. 1998 Dec;134(12):1575-80. doi: 10.1001/archderm.134.12.1575.
To assess the value of extensive laboratory screening for the identification of causes in patients with chronic urticaria and/or angioedema.
In a prospective study involving 220 patients, 2 diagnostic strategies were compared: the combination of detailed history taking and limited laboratory investigations vs detailed history taking and extensive laboratory screening. The results of the extensive screening program were initially kept secret from the patients and the physicians. Later, all results were disclosed, and an investigation was undertaken to find out whether this information changed the initial diagnosis. The patients were followed up for 1 year to evaluate the results of interventions and to detect latent causes.
The study was performed in the outpatient department of a secondary and tertiary care center with institutional practice.
A total of 238 consecutive new patients with chronic urticaria and/or angioedema edema were referred; 18 of them refused participation. One patient was unavailable for follow-up.
The difference in the number of identified causes between both approaches and the nature of the causes that would have been missed by omitting extensive laboratory screening.
With a questionnaire and the limited laboratory tests, a cause was found in 45.9% of the patients, compared with 52.7% with the questionnaire and the extended screening program. Except for one parasitic infection, missed diagnoses were mainly adverse reactions to drugs or food detected by standard elimination procedures, not by laboratory investigations.
Routine laboratory screening did not contribute substantially to the diagnosis of chronic urticaria or to the detection of underlying disorders.
评估广泛的实验室筛查对于确定慢性荨麻疹和/或血管性水肿患者病因的价值。
在一项涉及220例患者的前瞻性研究中，比较了两种诊断策略：详细病史采集与有限的实验室检查相结合，以及详细病史采集与广泛的实验室筛查。广泛筛查项目的结果最初对患者和医生保密。后来，所有结果都被公开，并进行了一项调查，以了解这些信息是否改变了初始诊断。对患者进行了1年的随访，以评估干预结果并检测潜在病因。
该研究在一家具有机构实践的二级和三级护理中心的门诊部进行。
总共转诊了238例连续性慢性荨麻疹和/或血管性水肿新患者；其中18例拒绝参与。1例患者无法进行随访。
两种方法在确定病因数量上的差异，以及省略广泛实验室筛查会遗漏的病因性质。
通过问卷调查和有限的实验室检查，45.9%的患者找到了病因，而通过问卷调查和扩展筛查项目这一比例为52.7%。除了一例寄生虫感染外，漏诊主要是通过标准排除程序检测到的药物或食物不良反应，而非实验室检查。
常规实验室筛查对慢性荨麻疹的诊断或潜在疾病的检测贡献不大。
