CAJ | 학술논문

目的通过前瞻性研究探讨症状相关概率(SAP)诊断胃食管反流性咳嗽(GERC)的最佳标准,以提高诊断精确性.方法选择2011年7月至2013年2月连续在同济大学附属同济医院呼吸内科门诊就诊的可疑GERC患者,进行多通道食管腔内阻抗-pH值监测检查,结合患者日记卡上咳嗽记录计算SAP,并经药物抗反流试验证实诊断.根据最高的Youden指数确立SAP诊断GERC的最佳标准,分析其敏感度、特异度、阳性预测值和阴性预测值,计算AUCROC和Kappa值,并与国内外SAP 诊断标准相比较.结果在纳入的103例中,87例(84.5％)患者最终确诊为GERC,其中酸反流引起者54例(62.1％),非酸反流引起者33例(37.9％).SAP≥80％时Youden指数最高(0.372),AUCROC 值为0.686,Kappa值为0.264,诊断GERC的敏感度为74.7％,特异度62.5％,阳性预测值91.5％,阴性预测值31.3％,维持较高诊断敏感度和特异度之间的平衡,优于国内SAP≥75％和国际≥95％的诊断标准.结合DeMeester积分≥12.7的条件,则AUCROC值为0.820,Kappa值0.689,敏感度87.0％,特异度76.0％,阳性预测值94.1％,阴性预测值80.0％,诊断效率和精确性与单纯SAP≥80％比较有进一步提高.结论 SAP≥80％可能是GERC的更合适诊断标准.
목적 통과전첨성연구탐토증상상관개솔(SAP)진단위식관반류성해수(GERC)적최가표준,이제고진단정학성.방법 선택2011년7월지2013년2월련속재동제대학부속동제의원호흡내과문진취진적가의GERC환자,진행다통도식관강내조항-pH치감측검사,결합환자일기잡상해수기록계산SAP,병경약물항반류시험증실진단.근거최고적Youden지수학립SAP진단GERC적최가표준,분석기민감도、특이도、양성예측치화음성예측치,계산AUCROC화Kappa치,병여국내외SAP 진단표준상비교.결과 재납입적103례중,87례(84.5％)환자최종학진위GERC,기중산반류인기자54례(62.1％),비산반류인기자33례(37.9％).SAP≥80％시Youden지수최고(0.372),AUCROC 치위0.686,Kappa치위0.264,진단GERC적민감도위74.7％,특이도62.5％,양성예측치91.5％,음성예측치31.3％,유지교고진단민감도화특이도지간적평형,우우국내SAP≥75％화국제≥95％적진단표준.결합DeMeester적분≥12.7적조건,칙AUCROC치위0.820,Kappa치0.689,민감도87.0％,특이도76.0％,양성예측치94.1％,음성예측치80.0％,진단효솔화정학성여단순SAP≥80％비교유진일보제고.결론 SAP≥80％가능시GERC적경합괄진단표준.
Objective To explore the optimal cut-off point of symptom association probability (SAP) in the diagnosis of gastroesophageal reflux-induced chronic cough (GERC) and therefore to improve the diagnostic accuracy.Methods Patients with suspected GERC consecutively referred to our respiratory clinic were enrolled into this prospective study between July 2011 and February 2013.After multi-channel intraluminal esophageal impedance and pH monitoring,SAP was calculated by associating the cough recordings on the patients' diary with the detected reflux.GERC was confirmed when there was a favorable response to the following anti-reflux therapy despite the laboratory findings.The optimal cutoff point of SAP was defined according to the highest Youden index.Then,the sensitivity,specificity,positive and negative predictive values,the area under the curve of ROC,and the Kappa value for the optimal cut-off point of SAP was calculated and compared to those of SAP standards currently used in China or generally accepted in the diagnosis of GERC.Results During the study period,103 patients with suspected GERC were recruited.Among them,GERC was confirmed in 87 patients (84.5％),including 54 patients (62.1％) due to acid reflux and 33 patients (37.9％) due to non-acid reflux.The optimal cut-off point of SAP was defined at≥ 80％ based on the highest Youden index of 0.372.For the diagnosis of GERC,SAP ≥80％ had the area under the curve of ROC of 0.686,the Kappa value of 0.264,the sensitivity of 74.7％,the specificity of 62.5％,positive predictive value of 91.5％ and negative predictive value of 31.3％ respectively,which were superior to those of SAP≥75％ currently used in China,and to those of SAP≥95％ (the generally accepted cut-off) in that the balance between higher sensitivity and higher specificity was maintained.When combined with DeMeester score≥ 12.7,the diagnostic accuracy of SAP ≥ 80％ was further improved,with the area under the curve of ROC of 0.820,the Kappa value of 0.689,the sensitivity of 87.0％,the specificity of 76.0％,positive predictive value of 94.1％ and negative predictive value of 80.0％.Conclusion SAP ≥80％ may be a more suitable standard for the diagnosis of GERC.