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目的评价标准皮试用变应原皮肤点刺试验(skin prick test,SPT)、血清总IgE(TIgE)测定及嗜酸性粒细胞计数(eosinophil count,EOS)在儿童哮喘临床诊断中的价值。方法收集2007-2010年在本院儿科门诊及住院部就诊怀疑哮喘的所有儿童,选取均检测SPT、TIgE、外周血EOS水平和肺功能的患儿549例,以临床标准(临床症状和肺功能)作为金标准最终确诊358例为哮喘(包括咳嗽变异型哮喘),191例为其他疾病,包括上呼吸道感染、肺炎、湿疹、荨麻疹、慢性咳嗽(非咳嗽变异性哮喘)、过敏性鼻炎、结核等。作出受试者工作特征曲线(ROC曲线),确定诊断截断点(cut off points)TIgE为88 IU/ml,EOS为288×106个/L。结果应用非参数法估计儿童哮喘的3种检验方法曲线下面积:EOS为0.699(95%CI0.655～0.744),TIgE为0.827(95%CI0.793～0.862),SPT为0.806(95%CI0.766～0.847)。检验的灵敏度、特异度、正确率、阳性预测值、阴性预测值,TIgE分别是85.5%、64.7%、77.2%、77.9%、75.9%;SPT分别是87.5%、71.8%、81.6%、83.8%、77.5%;而EOS分别是77.5%、46.8%、61.9%、58.7%、68.1%;TIgE+SPT平行试验分别是81.4%、75.2%、79.6%、89.1%、61.8%;TIgE+SPT系列试验分别是94.2%、64.1%、79.2%、72.6%、91.6%。结论 TIgE与SPT的灵敏度、特异度、正确率、阳性预测值、阴性预测值相似,且均优于EOS,无论是平行试验还是系列试验,TIgE+SPT的组合均优于各组中的其他组合,TIgE+SPT的联合试验对变应性哮喘的诊断意义较大。
Objective To evaluate the value of skin prick test (SPT), total serum IgE (TIgE) and eosinophil count (EOS) in the clinical diagnosis of childhood asthma. Methods A total of 549 children with suspected asthma were collected from pediatric outpatient department and inpatient department of our hospital during 2007-2010. 549 children with SPT, TIgE, peripheral blood EOS and pulmonary function were selected. The clinical criteria (clinical symptoms and lung function ) Of the 358 cases finally diagnosed as the gold standard for asthma (including cough variant asthma) and 191 cases for other diseases including upper respiratory tract infection, pneumonia, eczema, urticaria, chronic cough (non-cough variant asthma), allergic rhinitis, Tuberculosis and so on. The receiver operating characteristic curve (ROC curve) was established. The diagnostic cut off points were 88 IU / ml for TIgE and 288 × 106 cells / L for EOS. Results The area under the curve of the three test methods for non-parametric estimation of asthma in children was 0.699 (95% CI 0.665-0.744) for EOS, 0.827 (95% CI 0.793-0.862) for TIgE and 0.806 (95% CI0 .766 ~ 0.847). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of TIgE were 85.5%, 64.7%, 77.2%, 77.9% and 75.9%, respectively. The SPT was 87.5%, 71.8%, 81.6% and 83.8% , 77.5%, respectively; while the EOS was 77.5%, 46.8%, 61.9%, 58.7% and 68.1%, respectively. The TIgE + SPT parallel tests were 81.4%, 75.2%, 79.6%, 89.1% and 61.8% Respectively 94.2%, 64.1%, 79.2%, 72.6%, 91.6%. Conclusions The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TIgE and SPT are similar, and both are better than EOS. The combination of TIgE + SPT is superior to other combinations in either group, whether in parallel or in series , TIgE + SPT joint test on the diagnosis of allergic asthma more significance.