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目的探讨不同地区尘肺诊断差异的原因,为提高尘肺病诊断读片的准确性和一致性提供依据。方法选择因行肺灌洗治疗和行高千伏X线检查的不同地区经原单位诊断(地方诊断组)的尘肺病患者163例,高千伏X射线胸片由5名有经验的尘肺病诊断医师(课题专家诊断组)进行集体读片诊断;对诊断期别结果记录表采用统计学方法分析课题专家诊断组2次读片结果及课题诊断组与地方诊断组读片结果的差异。结果课题专家诊断组2次诊断结果,经一致性的Kappa值分析,结果 Kappa值=0.807>0.75,说明2次诊断结果存在相当满意的一致程度,诊断符合率85.89%;地方诊断组和专家诊断组的Kappa值=0.177<0.4,说明2组结果一致程度不够理想,诊断符合率49.69%。各地方诊断组与课题专家诊断组在变异系数(CV%)、过高诊断率、过低诊断率、相符合率方面存在差异,分别为7.19%～75.22%,7.14%～83.33%,0.00～66.67%,14.29%～87.50%。结论地方诊断组和课题专家诊断组存在读片差异,应通过控制相应条件,提高胸片质量、准确把握诊断标准、定期培训、对照标准片集体读片、坚持实事求是和提高诊断人员职业道德,必要时行CT鉴别诊断可以缩小诊断误差,提高诊断准确率。
Objective To explore the causes of pneumoconiosis diagnosis in different areas and provide the basis for improving the accuracy and consistency of pneumoconiosis diagnostic reading. Methods Sixty-three patients with pneumoconiosis who were diagnosed by the original unit (local diagnosis group) in different areas undergoing lung lavage treatment and high kV X-ray examination were selected. The high-kV radiographic chest radiographs were obtained from five experienced pneumoconiosis patients The diagnostic physician (subject expert diagnosis group) conducted a collective read-out diagnosis, and the statistical results were used to analyze the difference between the second-read result of the subject expert diagnosis group and the result of the subject diagnosis group and the local diagnosis group. Results The results of the expert diagnosis group 2 diagnostic results, the consistency of the Kappa value analysis, the results Kappa value = 0.807> 0.75, indicating that there is a satisfactory agreement between the two diagnostic results, the diagnostic coincidence rate of 85.89%; local diagnostic group and expert diagnosis The Kappa value of the group = 0.177 <0.4, indicating that the consistency of the two groups of results is not ideal, the diagnostic coincidence rate of 49.69%. There were differences in coefficient of variation (CV%), overdiagnosis rate, overdiagnosis rate, and coincidence rate between local diagnostic group and subject diagnostic group, which ranged from 7.19% to 75.22%, 7.14% to 83.33% 66.67%, 14.29% ~ 87.50%. Conclusion There is a difference between the local diagnosis group and the subject expert diagnosis group. It is necessary to improve the quality of the x-ray film by controlling the corresponding conditions, accurately grasp the diagnostic criteria, train regularly and collect the reference tablets collectively, insist on seeking truth from facts and enhancing the professional ethics of the diagnosticians. Time line differential diagnosis of CT can reduce the diagnostic error, improve diagnostic accuracy.