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目的比较饮水型地方性氟骨症临床表现诊断与X线诊断的差异,评价临床表现对该病的诊断价值,为按照临床表现对该病进行早期诊断提供理论依据。方法调查244例高氟病区居民的临床症状和体征,统计各种症状、体征检出率,并依据临床表现进行诊断与分度;拍摄骨关节X线照片,按照WS192-1999标准进行X线诊断与分度;比较临床与X线方法诊断及分度结果的差异;计算临床诊断方法的真实性、可靠性等指标,并根据上述指标对其诊断价值进行评价。结果饮水型地方性氟骨症最常见的临床表现为骨关节的疼痛和僵硬;临床和X线方法检出率分别为69.3%和63.1%,两种方法诊断结果的差异没有统计学意义(P>0.05);临床与X线诊断方法的符合率为69.3%;二者在分度上表现出交叉;临床诊断方法灵敏度为80.5%,特异度为50.0%,假阴性率为19.5%,假阳性率为50.0%;ROC曲线下面积为0.653。结论临床与X线诊断方法对氟骨症的检出率相同。依据临床表现对该病进行诊断的特异度不高,可能由于临床表现为非客观性指标,不好控制;临床表现诊断法误诊率较高;临床诊断与X线诊断方法对该病的诊断结果较一致,虽不可单独诊断,却可为确诊该病提供重要线索。
Objective To compare the difference between the clinical manifestations and X-ray diagnosis of endemic fluorosis in drinking-water and to evaluate the clinical value of clinical manifestations in the diagnosis of the disease, and to provide a theoretical basis for the early diagnosis of the disease according to the clinical manifestations. Methods We investigated the clinical symptoms and signs of 244 residents with high fluoride in the area. According to the clinical symptoms and signs, the incidences of various symptoms and signs were detected. According to the standard of WS192-1999, Diagnosis and indexing; compare the difference between clinical and X-ray diagnosis and indexing results; calculate the authenticity, reliability and other indicators of clinical diagnostic methods, and evaluate the diagnostic value according to the above indexes. Results The most common clinical manifestation of drinking-type endemic fluorosis was joint pain and stiffness. The detection rates of clinical and X-ray were 69.3% and 63.1%, respectively. There was no significant difference between the two methods (P > 0.05). The coincidence rate of clinical diagnosis and X-ray diagnosis was 69.3%. The two methods showed a cross in indexing. The sensitivity of clinical diagnosis was 80.5%, specificity was 50.0%, false negative rate was 19.5%, false positive The rate was 50.0%; the area under the ROC curve was 0.653. Conclusion Clinical and X-ray diagnostic methods have the same detection rate of skeletal fluorosis. According to the clinical manifestations of the disease diagnosis is not specific, may be due to clinical manifestations of non-objective indicators, not controlled; clinical diagnosis of misdiagnosis rate is higher; clinical diagnosis and X-ray diagnosis of the disease diagnosis More consistent, although not a single diagnosis, but it can provide important clues for the diagnosis of the disease.