不同诊断标准对肌萎缩侧索硬化预后评估的价值
Values of different diagnosis criteria for predicting the prognosis of amyotrophic lateral sclerosis
目的 评价不同的诊断标准对肌萎缩侧索硬化(ALS)患者预后评估的价值.方法 选择2011年1月至2012年12月期间就诊于北医三院并诊断为ALS的患者,收集首次就诊时基线资料,并分别依据Airlie House标准和Awaji-shima标准完成对诊断的分级,对入选病例完成发病后24个月的随访,通过ROC曲线评价这两种诊断标准对预后的预测价值.结果 根据Airlie House标准和Awaji-shima诊断标准,不同诊断级别的患者中其发生终点事件的比率差异均无统计学意义(均P>0.05).诊断延迟时<12个月亚组中,依据Airlie House标准,高诊断级别患者终点事件的发生率显著高于低诊断级别组,差异有统计学意义(x2=43.283,P<0.001).对于诊断延迟时间<12个月且非球部起病的患者,Airlie House标准构建预测预后的ROC曲线下面积为0.603,与基准线面积(0.500)相比,差异有统计学意义(P=0.045).结论 Airlie House标准可以预测诊断延迟时间<12个月且非球部起病的患者的预后.
更多Objective To evaluate the value of different diagnosis criteria for predicting the prognosis of amyotrophic lateral sclerosis (ALS).Methods Between January 2011 and December 2012,all patients with a diagnosis of ALS referred to and assessed at Peking University Third Hospital (PUTH) were screened.Baseline demographic details and clinical data were collected from the patient's first visit to PUTH.According to the Airlie House and Awaji-shima criteria, the levels of diagnostic certainty were categorized.The follow-up period was 24 months.Receiver operating characteristic (ROC) curves were made to compare the efficiency of the two ALS-criteria.Results According to the Airlie House and Awaji-shima criteria, there was no difference in the outcome event rate among the different levels of diagnostic certainty (P>0.05).Among the sub-group with diagnostic delay time <12 months, the outcome event rate of high diagnostic level patients was higher than that of low diagnostic level patients (x2=43.283, P <0.05).For the non-bulbar onset patients whose diagnostic delay time was under 12 months, the areas under the ROC curves of the Airlie House to predict the prognosis of ALS was 0.603, which was significantly higher than the baseline area of 0.500 (P<0.05).Conclusion The Airlie House criteria can predict the prognosis of non-bulbar onset ALS whose diagnostic delay time were under 12 months.
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