喘息の症状の診断精度

喘息の所見について。

Eur Respir J

 

. 2001 Feb;17(2):214-9.

 doi: 10.1183/09031936.01.17202140.

Clinical Diagnosis of Current Asthma: Predictive Value of Respiratory Symptoms in the SAPALDIA Study. Swiss Study on Air Pollution and Lung Diseases in Adults

D Sistek ¹, J M Tschopp, C Schindler, M Brutsche, U Ackermann-Liebrich, A P Perruchoud, P Leuenberger

 

 

スイスで募集された18-60歳の9651名のうち、医師により喘息と診断された225名(2.3%)の症状を集計して、感度・特異度などを算出。

 

 

Diagnostic value of isolated symptoms

 

症状	感度%	特異度%	PPV%	NPV%	J
Wheeze(喘鳴)	74.7	87.3	12.4	99.3	0.62
Wheezing with dyspnoea(喘鳴＋呼吸困難)	65.2	95.1	23.9	99.1	0.6
Wheezing without cold(感冒なしの喘鳴)	59.8	93.6	18.2	99	0.53
Nocturnal chest tightness(夜間の胸部圧迫感)	49.3	86.4	8	98.6	0.36
Rest dyspnoea(安静時呼吸困難)	47.1	94.9	18	98.7	0.42
Exercise dyspnoea(労作時呼吸困難)	69.3	75.7	6.4	99	0.45
Nocturnal dyspnoea(夜間の呼吸困難)	46.2	96	21.5	98.7	0.42
Nocturnal cough(夜間の咳嗽)	49.3	72.3	4.1	98.4	0.22
Chronic cough(慢性咳嗽)	21.5	95.2	9.6	98.1	0.17
Chronic phlegm(慢性排痰)	22.7	93.3	7.5	98.1	0.16
Chronic bronchitis(慢性気管支炎)	12.5	98.2	14	97.9	0.11

• S: sensitivity; SP: specificity; PPV: positive predictive value; NPV: negative predictive value; J: Youden index.

 

夜間の咳嗽以外は、陽性所見ならば喘息の可能性を上げる。

喘鳴・喘鳴＋呼吸困難、感冒なしの喘鳴、労作時呼吸困難が陰性ならば可能性が下がる。

 

症状の組み合わせによる精度；

 

Diagnostic value of symptom combinations in the diagnosis of active asthma

 

Symptom combination	S%	SP%	PPV%	NPV%	J
W and NCT	40.9	97.5	28.1	98.6	0.38
W and RD	38.4	98.7	42	98.5	0.37
W and ED	54.2	95.7	23.1	98.9	0.5
W and ND	37.5	98.6	39.3	98.5	0.36
W and (RD a/o ND)	51.3	98	38.3	98.8	0.49
W and (RD a/o ND a/o NCT)	56.3	96.8	29.4	98.9	0.53
W and (RD a/o ND a/o ED a/o NCT)	65.2	94.5	21.9	99.1	0.6
(W a/o NC) and (RD a/o ND)	57.8	95.8	24.8	99	0.54
(W a/o NC) and (RD a/o ND a/o NCT)	63.1	91.6	15.2	99	0.55
(W a/o NC) and (RD a/o ND a/o ED a/o NCT)	75.1	84.6	10.5	99.3	0.6
(W a/o NCT) and (RD a/o ND a/o NC)	67.9	89.7	13.6	99.2	0.58
(W a/o NCT) and (RD a/o ND)	58	95.6	23.8	99	0.54
(W a/o ND) and NCT	46.2	95.8	20.7	98.7	0.42
(W a/o ND) and RD	43.6	97.9	32.9	98.6	0.41
W a/o 2 nocturnal symptoms	80	85.9	11.9	99.4	0.66
(NC a/o ND a/o NCT)	75.1	63.5	4.7	99.1	0.3

• S: sensitivity; SP: specificity; PPV: positive predictive value; NPV: negative predictive value; J: Youden index.

• W: any wheezing; NCT: nocturnal chest tightness; RD: rest dyspnoea; ED: exercise dyspnoea; ND: nocturnal dyspnoea; NC: nocturnal cough; a/o: and/or; nocturnal symptoms: NCT, ND or NC.

 

組み合わせで、感度の高いのは、喘鳴＋夜間症状が2つのみ。