亚洲妇女骨质疏松自我评价工具应用于我国大陆地区绝经后妇女骨质疏松的筛检效果评价

目的 探讨亚洲妇女骨质疏松自我评价工具(OSTA)应用于我国大陆地区绝经后妇女的筛选效果,为促进我国骨质疏松筛检工具的研究与建立提供参考依据.方法 利用我国"骨密度参考数据库"中绝经后妇女股骨颈骨密度的数据,根据OSTA计算公式得到每个被测者的OSTA得分,依据其筛选临界值将所有对象划分为3个危险性等级或有、无骨质疏松危险性两类,并与双能X线骨密度仪(DXA)测定的股骨颈骨密度所得T-score进行对比分析,通过灵敏度、特异度、Kappa值、ROC曲线下面积等指标进行评价.结果 按照三级筛选界值进行骨质疏松危险性判定,Kappa=0.357(P＜0.001);按两类界值.Kappa＝0.418(P＜0.001).灵敏度为73.8%,特异度为68.2%,阳性预测值为76.1%,阴性预测值为65.4%.结果 均表明OSTA与T-score的分类一致性较差.调整临界值后,该分类一致性没有得到改善.经ROC分析,曲线下面积为0.789,表明OSTA具有中等应用价值.结论 OSTA在我国的临床适用性不理想.因此,探索适用于我国大陆地区绝经后妇女的骨质疏松筛检工具仍具有重要的现实意义.     

抗逆转录病毒治疗对艾滋病患者认知功能影响研究

目的观察高效抗逆转录病毒治疗(highly active antiretroviral therapy,HAART)对维持性血液透析(maintenance hemodialysis,MHD)和未进行维持性血液透析的HIV/AIDS患者认知功能影响情况,为改善其认知功能及生活质量提供参考依据。方法收集2016年1月-2018年6月在南宁市第四人民医院(广西艾滋病临床治疗中心)同时进行规律血液透析及HAART的43例HIV/AIDS MHD患者基本资料,以简易精神状态检查量表(mini-mental state examination,MMSE)及国际人类免疫缺陷病毒相关性痴呆量表(International HIV-Associated Dementia Scale,IHDS)评分评估患者HAART前后认知功能状况,并以同期40例HAART未进行维持性血液透析的HIV/AIDS患者作为对照组进行对比研究,分析其可能影响因素。结果HAART前两组患者MMSE、IHDS得分无统计学差异(P>0.05);对照组经HAART治疗开始第3个月、6个月及12个月后,MMSE得分较HAART前显著升高(P均<0.00);IHDS得分在HAART后第3个月较HAART前无明显统计学差异(P>0.05),至第6个月、第12个月,与HAART治疗前相比,IHDS得分得到明显改善(P均<0.00);观察组HAART治疗第3个月、6个月后,MMSE得分较HAART前有所升高(P均<0.00);IHDS得分第3个月较HAART前比较尚无明显统计学差异(P>0.05);至6个月后,IHDS得分较HAART前有所升高(P<0.05),但得两者分数值均低于对照组(P均<0.00),至第12个月,MMSE及IHDS得分较HAART后第6个月均出现下降,两者比较有统计学差异(P<0.00),且MMSE得分及IHDS得分明显低于对照组(P均<0.00)。结论维持性血液透析HIV/AIDS患者HAART前普遍存在明显认知功能障碍,HAART治疗能在短时间内有效改善患者认知功能,长期血液透析后认知功能出现逐级下降,值得临床重视。     

症状筛查与影像学检查在结核杆菌/艾滋病病毒双重感染监测中的应用评价

目的对结核病可疑症状问卷筛查和影像学检查方法的效果进行评价,为完善广西结核杆菌/艾滋病病毒(Mycobacterium Tuberculosis and Human Immunodeficiency Virus,TB/HIV)双重感染监测系统提供依据。方法在三个艾滋病疫情较高的地区建立结核病监测点,对就诊和随访的艾滋病病毒感染者和病人(People Living with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome,HIV/AIDS)开展结核病症状筛查、影像学检查和痰标本检测,评价症状筛查和影像学检查的检测效度、信度及其并联试验效果。结果 2013-2015年,共纳入1024例HIV/AIDS,确诊活动性结核72例,无感染或罹患结核的受检者653例。症状筛查和影像学检查的阳性率分别为:34.28%和17.58%。诊断结核病的概率随着可疑症状出现项目的增多呈现升高趋势(P0.001)。18.75%的诊断病例影像学检查结果阴性。结核病可疑症状筛查的灵敏度为69.44%,特异度为83.61%,Kappa值为0.348(与金标准弱一致);影像学检查的灵敏度为65.27%,特异度为93.72%,Kappa值为0.537(与金标准中度一致)。联合筛查并联试验灵敏度提高至88.89%;两项筛查均阳性的似然比远大于其中一项阳性或均阴性者(42.76VS1.54,3.73,0.14)。结论HIV/AIDS合并结核病时,由于免疫反应的低下,症状不典型,部分患者的胸部影像学检查结果不易判断。单项常规筛查方法对病例的确认和排除精度有限。因此,在对HIV/AIDS进行结核病筛查时,需采用多种临床诊断路径和实验室方法进行反复验证核实。     

应用决策树模型研究男男同性性行为人群HIV感染者总淋巴细胞计数与CD_4~+T细胞计数的相关性

目的应用决策树模型(CART)研究MSM人群HIV感染者总淋巴细胞计数(TLC)与CD_4~+T细胞计数的相关性,并与常规ROC分类方法比较。方法选取137例MSM人群HIV感染者,所有病例均未接受抗病毒治疗,采集203例血样标本,检测血常规指标和CD_4~+T细胞计数,把与CD_4~+T细胞计数显著相关的血常规指标纳入CART模型,计算灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和约登指数。结果 203例血样标本的总淋巴细胞计数(TLC)与CD_4~+T细胞计数分别为(1 771.9±720.3)cells/μL、(410.9±201.4)cells/μL,两者呈显著正相关(r=0.603,P0.001)。CART模型分类CD_4~+T细胞计数≤350 cells/μL的灵敏度、特异度、PPV、NPV和约登指数分别为66.7%、70.4%、58.4%、77.2%和0.371,CART模型分类CD_4~+T细胞计数≤500 cells/μL的灵敏度、特异度、PPV、NPV和约登指数分别为93.8%、53.5%、83.4%、77.5%和0.473;两个CART模型均优于ROC分类方法。结论 TLC与CD_4~+T细胞计数显著相关,TLC分类预测MSM人群HIV感染者CD_4~+T细胞计数具有良好的灵敏度和特异度,在资源有限地区可以用于MSM人群艾滋病疾病进展监测,应用CART模型纳入多个指标联合预测的效果更佳。     

CT内脏脂肪面积与急性胰腺炎严重程度和预后相关性分析

目的急性胰腺炎是临床上诊治棘手的急腹症之一,本研究探讨CT内脏脂肪面积对急性胰腺炎(acute pancreatitis,AP)严重程度和预后的预测价值。方法收集2019-01-27-2019-07-15收治的75例AP患者临床和发病早期(72h内)CT影像学资料,使用灵敏度、特异度和Kappa值等指标评价内脏脂肪面积对AP相关持续性器官功能衰竭和住院期间死亡的预测价值。结果发生持续性器官功能衰竭的AP患者内脏脂肪面积为(180.6±54.2)cm2,大于未发生持续性器官功能衰竭者的(136.5±39.0)cm2,t=2.896,P=0.005;住院期间死亡患者内脏脂肪面积为(219.7±39.5)cm2,大于存活者的(136.8±38.6)cm2,t=5.728,P0.001。以CT内脏脂肪面积167cm2为界点,预测持续衰竭的灵敏度为75.0%、特异度为82.1%、约登指数为0.571、Kappa值为0.368。以CT内脏脂肪面积175cm2为界点,预测死亡的灵敏度为100%、特异度为84.5%、约登指数为0.845、Kappa值为0.368。内脏脂肪面积对持续性器官功能衰竭(AUC=0.754,95%CI:0.553～0.954)和住院期间死亡(AUC=0.944,95%CI:0.872～1.015)均具有一定诊断价值。结论急性胰腺炎发病早期CT下脐平面内脏脂肪面积与患者发生持续性器官功能衰竭和住院期间死亡存在相关,但对预测AP严重程度和预后效果有限。     

第一秒用力呼气容积与第六秒用力呼气容积比值及第六秒用力呼气容积在阻塞及限制性肺通气功能障碍中诊断价值的研究

目的探讨应用第6秒用力呼气容积（FEV6）替代用力肺活量（rvc）用于阻塞性及限制性肺通气功能障碍的诊断。方法对470例行肺功能检查的门诊患者进行回顾性分析,分别以第1秒用力呼气容积（FEV6）／FVC〈70％及FEV,／FVC正常而FVC占预计值百分比〈80％为标准,绘制受试者工作特征曲线,以灵敏度与特异度之和最大为标准,分别确定FEV1／FEV6及FEV6占预计值百分比的最佳诊断界值及灵敏度与特异度。采用交叉列联表方法计算准确率,采用Kappa检验判定一致性。结果以FEV。／FVC〈70％为金标准,FEV1／FEV6诊断阻塞性及限制性肺通气功能障碍的最佳诊断界值为71％,灵敏度为97．5％（154／158）,特异度为98．7％（308／312）,准确率为98．3％（462／470）,Kappa=0．962（P=0．000）;以FEV1／FVC正常而FVC占预计值百分比〈80％为金标准,FEV。占预计值百分比诊断限制性肺通气功能障碍的最佳诊断界值为82％,灵敏度为96．1％（73,76）,特异度为95．7％（222／232）,准确率为95．8％（295／308）,Kappa=0．890（P=0．000）。结论FEV6可以有效替代FVC用于阻塞性及限制性肺通气功能障碍的诊断,FEV1／FEV6诊断阻塞性及限制性肺通气功能障碍的最佳诊断界值为71％,FEV6占预计值百分比诊断限制性肺通气功能障碍的最佳诊断界值为82％。     

BED捕获酶联免疫试验检测HIV新近感染者的敏感度和特异度

目的:确定BED捕获酶联免疫试验(BED法)检测发现HIV新近感染者的灵敏度和特异度。方法:以云南省德宏州感染时间>168 d的HIV感染者为"真正的"既往感染者,以感染时间≤168 d的HIV感染者为"真正的"新近感染者,对其血清标本采用BED法进行检测。结果:29例新近感染者中BED检测阳性共24例,灵敏度为82.76%;264例既往感染者中BED检测阴性共218例,特异度为82.58%;感染者感染时间越长,BED特异度越高,而对于感染时间在169 d～365 d的感染者,BED特异度低、假阳性率高。结论:BED法在确定HIV新近感染者时具有较高的灵敏度和特异度,但对部分感染者存在一定的误判率。     

足月新生儿缺氧缺血性脑病早期脑功能分析

目的:探讨振幅整合脑电图(aEEG)在足月新生儿缺氧缺血性脑病(HIE)早期诊断中的价值.方法:选取2012年1月～2013年12月该院收治的足月HIE患儿50例,在其出生后3～12 h进行aEEG动态监测.从背景活动、睡眠-清醒周期(SWC)和惊厥发作(SA)3个方面分析aEEG结果与HIE临床分度的相关性,评价aEEG在HIE早期诊断中的灵敏度、特异度、阳性预测值及阴性预测值.结果:50例HIE患儿中aEEG正常26例(52.0％),轻度异常14例(28.0％),重度异常10例(20.0％);aEEG异常程度与HIE临床分度呈正相关性(r=0.684,P＜0.05);aEEG对中重度HIE早期诊断的灵敏度为86.4％、特异度为93.3％、阳性预测值为95.0％、阴性预测值为82.4％,与HIE临床分度具良好一致性(Kappa值=0.612,P＜0.05);aEEG SWC对中重度HIE早期诊断的灵敏度为81.8％、特异度为100.0％;重度HIE患儿8例出现SA,以aEEG SA预测中重度HIE的灵敏度为77.3％、特异度为100.0％.结论:出生后早期及时监测aEEG有助于早期诊断HIE,并可预测病情的轻重程度.     

湖南农村老年女性艾滋病感染者自感羞辱与社会支持

目的 了解湖南农村老年女性人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者自感羞辱水平及社会支持的情况。方法 选取永州农村地区老年女性HIV感染者为研究对象,于2017年1月~2018年1月调查其自感羞辱程度以及社会支持现状。结果 农村老年女性感染者其自感羞辱总得分为（33.36±9.31）分,高于同人群老年男性（t=11.59,P<0.001）,责备维度的得分低于老年男性（t=-6.14,P<0.001）。汉族、依靠儿女赡养的、独自居住老年女性HIV感染者自感羞辱程度较高,差异具有统计学意义（均有P<0.05）。此地区老年女性的社会支持程度较低,其客观支持得分与社交距离以及歧视维度的得分呈负相关（均有P<0.05）;主观支持与责备维度的得分呈正相关（r=0.27,P=0.005）;支持的利用度得分与责备维度的得分呈正相关（r=0.41,P<0.001）。结论 此地区老年女性HIV感染者的自感羞辱程度较同地区男性更高,而社会支持程度较非HIV感染的老年人群低。     

支持向量机对艾滋病病毒感染者初筛识别的研究

目的在描述性分析的基础上,应用支持向量机(support vector machines,SVM)建立艾滋病病毒(human im-munodeficiency virus,HIV)感染者的识别模型。方法以2004-2009年某省口岸在出入境人员中检出的133例HIV感染者及非HIV感染者133例组成研究对象,进行流行病学描述性分析。以是否感染HIV为因变量,以年龄、性别、国籍、文化程度、职业、劳务史、会阴部症状史、不洁性生活史、吸毒史、输血史、性伴侣是高危人员、是否有同性性行为、性伴侣数为自变量建立SVM模型,分析预测效果和预测变量的重要性。结果 HIV感染者以35~44岁年龄为主(48.87%),男性占93.23%,劳务人员占48.12%,性伴侣2人及以上的占51.88%,承认不洁性生活史占39.10%,承认有同性性行为占3.76%。SVM模型识别总体准确率为90.60%(灵敏度90.29%,特异度90.90%)。预测变量重要程度以劳务史为首(0.80),其次是不洁性生活史(0.04)和性伴侣是高危人群(0.03)。结论口岸HIV感染者有其特定的流行病学特征,HIV感染者SVM识别模型的拟合能力强,能较好地用于评价口岸现场未知样本的初筛。     

艾滋病患者IHDS量表评分影响因素分析

目的了解广西壮族自治区艾滋病患者国际人类免疫缺陷病毒相关性痴呆量表(IHDS)评分的影响因素,为采取相应干预措施提供参考依据。方法随机抽取南宁市第四人民医院2010年11月-2011年3月收治入院的100例年龄<65周岁HIV血清阳性患者进行IHDS问卷调查。结果艾滋病患者IHDS得分为(8.06±1.81)分;不同特征艾滋病患者IHDS得分比较,≤50岁患者得分为(8.79±1.94)分,高于51～64岁患者的(8.04±2.03)分(t=2.590,P=0.010);汉族患者得分为(9.56±1.70)分,高于壮族患者的(8.93±1.80)分(t=-9.329,P=0.041);小学未毕业患者得分为(7.33±1.37)分,低于小学毕业以上患者的(9.49±1.62)分(t=-7.861,P=0.000);饮酒患者得分为(8.41±1.54)分,低于非饮酒患者的(9.27±1.83)分(t=3.031,P=0.030);男性与女性患者得分分别为(8.92±1.81)和(9.27±1.75)分,吸烟与非吸烟患者得分分别为(8.91±1.60)和(9.15±1.93)分,不同性别、吸烟状况患者得分间差异均无统计学意义(P>0.05);多元线性Logistic回归分析结果表明,年龄越大、饮酒越多的艾滋病患者IHDS得分越低;受教育程度越高的艾滋病患者IHDS得分越高。结论年龄、文化程度和饮酒状况是艾滋病患者IHDS量表评分的主要影响因素。     

空腹血糖与糖化血红蛋白在2型糖尿病诊断中的应用

目的评估空腹血糖（FPG）和糖化血红蛋白（HbAlc）诊断2型糖尿病（T2DM）的敏感性和特异性。探讨FPG、HbAlc及联合指标诊断T2DM的最佳切点。方法采用WHO糖尿病诊断标准,将423例研究对象分为T2DM组（n=60）和非T2DM组（n=363）,所有受试者均行口服葡萄糖耐量试验（OGTT）,同时测定其FPG及HbAlc。绘制FPG和HbAlc诊断糖尿病的受试者工作曲线（ROC曲线）。结果①HbAlc诊断T2DM的切点为6．1％,此时灵敏度为91．7％,特异度为78．5％,曲线下面积0．910（95％CI,0．873～0．946）,阳性预测值（＋PV）为41．4％,阴性预测值（-PV）为98．3％,You＆n指数为O．702,正确率为80．4％,Kappa值为0．465。HbAlc≥6．5％时,灵敏度为61．7％,特异度为93．7％,＋PV为61．7％、-Py为93．7％,Youden指数为0．553,正确率为89．1％,Kappa值为O．553。②FPG诊断T2DM的切点为6．09mmol／L,此时灵敏度83．3％,特异度89．3％,曲线下面积0．898（95％CI,0．885-0,957）,＋PV50．5％,一州96．9％。Youden指数0．726,正确率86．1％,Kappa值0．549。当FPG≥7．00mmol／L时,灵敏度33．3％,特异度99．2％,＋w87．0％、-PV90．0％、Youden指数0．325、正确率89．8％、Kappa值0．438。③HbAlc≥6．1％和FPG≥6．09mmol／L联合指标具有较好的诊断性能。且优于单个指标,此时的灵敏度83．3％．特异度93．7％,＋PV68．5％,-PV97．1％,Youden指数0．770,正确率92．2％,Kappa值0．706。结论HbAlc≥6．1％和FPG≥6．09mmol／L联合指标具有很好的灵敏度和特异度,且Youden指数、正确率、Kappa值都高于其他指标,与OGTT有很好的一致性,对T2DM的诊断有较好应用价值。     

中国东部地区结核菌素试验诊断结核病感染临界值的确定：基于人群的现况调查

目的 确定结核菌素试验的临界值来降低其诊断结核病潜伏性感染的假阳性。方法 测量受试者的FPG值,同时对受试者做结核菌素试验和QuantiFERON-TB（QFT）Gold In-Tube检测。以QFT为金标准,确定结核菌素试验（TST）试验的临界值。结果 共有5 405名参与者,其中1 104名（20.4%）QFT阳性。在5 405例患者中,PPD硬结直径为10.25 mm时诊断价值最高,其灵敏度为0.731,特异度为0.727。将受试者分为正常人、有糖尿病史患者、新确诊糖尿病患者,硬结直径分别在11.25 mm、10.25 mm和11.25 mm时诊断价值最高,其灵敏度和特异度分别为0.701、0.837、0.824和0.805、0.821、0.778。结论 本研究证实,以10~12 mm作为结核病潜伏性感染诊断的临界值可以大大提高结核菌素试验的特异性。     

Mini-Mental Status Examination: a short form of MMSE was as accurate as the original MMSE in predicting dementia

OBJECTIVES: This study assesses the properties of the Mini-Mental State Examination (MMSE) with the purpose of improving the efficiencies of the methods of screening for cognitive impairment and dementia. A specific purpose was to determine whether an abbreviated version would be as accurate as the original MMSE in predicting dementia. STUDY DESIGN AND SETTING: A population-based post hoc examination of the performance characteristics of the MMSE for detecting dementia in an existing data set of 243 elderly persons. RESULTS: Sensitivity, specificity, and predictive values were computed for the original MMSE as well as new MMSE scale models derived from a Rasch model item analysis. The optimal threshold for the original MMSE screen yielded sensitivity and specificity estimates of 72.5% and 91.3%, respectively. The use of a subscale resulted in a slightly lower sensitivity (71.0%), specificity (88.4%), and positive predictive value (71.0%) but equal area under the receiver operating characteristic curve. Cross-validation on follow-up data confirmed the results. CONCLUSION: A short, valid MMSE, which is as sensitive and specific as the original MMSE for the screening of cognitive impairments and dementia is attractive for research and clinical practice, particularly if predictive power can be enhanced by combining the short MMSE with neuropsychological tests or informant reports.     

Prediction of probable Alzheimer disease in patients with symptoms suggestive of memory impairment. Value of the Mini-Mental State Examination

BACKGROUND: The Mini-Mental State Examination (MMSE) is a widely used diagnostic tool for dementia. Its use as a predictive indicator of probable Alzheimer disease (AD) has not been established. OBJECTIVES: To determine the accuracy of the MMSE in predicting emergent AD in a sample of patients who were referred because of symptoms suggestive of memory problems and to determine whether an abbreviated version of the MMSE could be developed that would be as accurate as the full MMSE in predicting emergent AD. DESIGN: Inception cohort of participants with symptoms suggestive of memory impairment by their family physicians were given baseline assessments, including MMSE. After 2 years, the participants' conditions were diagnosed following the standard criterion for AD. Diagnosticians were blind to baseline scores. SETTING AND PARTICIPANTS: One hundred eighty-three community-residing participants were referred by their family physicians to a university teaching hospital research investigation. After baseline screening, 165 participants were included in the study who did not have dementia and had no identifiable cause for memory impairment. After 2 years, 29 participants met criteria for AD, 98 did not develop dementia, 18 developed vascular lesions or non-AD dementia, and 20 did not return. MAIN OUTCOME MEASURE: Diagnostic classification of AD or no evidence of dementia. RESULTS: Logistic regression model was significant. At a cutoff score of 24 or less, sensitivity was 31%; specificity, 96%; with a likelihood ratio of 7.75. A reduced model of 2 subtests was identified with a sensitivity of 41%; specificity, 98%; with a likelihood ratio of 20.70. CONCLUSIONS: Results suggest that the full or abbreviated MMSE is useful in predicting emergent AD in patients with positive test results. However, it is not recommended for use as a screening or diagnostic instrument since a negative test result did not rule out emergent AD. It is recommended as a tool to identify those needing closer monitoring.     

Estimating diagnostic accuracy of multiple binary tests with an imperfect reference standard

The goal in diagnostic medicine is often to estimate the diagnostic accuracy of multiple experimental tests relative to a gold standard reference. When a gold standard reference is not available, investigators commonly use an imperfect reference standard. This paper proposes methodology for estimating the diagnostic accuracy of multiple binary tests with an imperfect reference standard when information about the diagnostic accuracy of the imperfect test is available from external data sources. We propose alternative joint models for characterizing the dependence between the experimental tests and discuss the use of these models for estimating individual‐test sensitivity and specificity as well as prevalence and multivariate post‐test probabilities (predictive values). We show using analytical and simulation techniques that, as long as the sensitivity and specificity of the imperfect test are high, inferences on diagnostic accuracy are robust to misspecification of the joint model. The methodology is demonstrated with a study examining the diagnostic accuracy of various HIV‐antibody tests for HIV. Published in 2008 by John Wiley & Sons, Ltd.     

Evaluation of a screening instrument for developmental coordination disorder.

PURPOSE: To validate the Children's Self-Perceptions of Adequacy in, and Predilection for Physical Activity (CSAPPA) scale as a proxy for the BOTMP test in diagnosing DCD. METHODS: A sample of 209 children (M = 121; F = 87) consented to the BOTMP test, CSAPPA scale, Participation Questionnaire, Léger 20-meter Shuttle Run, and body fat using bioelectric impedance. Receiver Operating Characteristic (ROC) curve analysis and Kappa statistic were used to validate the CSAPPA scale as a predictor for significant clumsiness on the BOTMP test. RESULTS: Prevalence of DCD was.09 +/-.03 of both males and females, all previously undiagnosed. A positive cutoff of < 47 and < 53 for DCD on the CSAPPA scale was identified in male and females, respectively. Both gender cut-offs demonstrated significant agreement (p <.01) with a positive BOTMP test. Males' results indicated a sensitivity and specificity values of.90 (CI =.18) and.89 (CI =.22). Likewise, the female subject cutoff demonstrated high sensitivity [.88 (CI =.05)] and specificity [75 (CI =.09)]. Gender specific analysis of variance (ANOVA) indicated that students identified as clumsy were not significantly different in age or height from their peers, but demonstrated significantly (p <.01) lower self-efficacy, aerobic fitness, and had significantly (p <.01) higher relative body fat. These results held true for both genders. CONCLUSIONS: These findings are consistent with the characteristics of children with DCD. These results suggest that the CSAPPA scale is a promising instrument for use in screening children for developmental coordination disorder.     

中文版儿童事件影响量表在汶川地震极重灾区中小学生中的应用及分析

目的 评价中文版(简体)儿童事件影响量表(CRIES-13)的信度和效度,探讨利用该量表筛检创伤后应激障碍(PTSD)的价值及最佳评分切割点.方法 采用分层随机整群抽样原则,选取253名汶川地震后幸存儿童作为被评估对象,采用量表白评和临床诊断相结合的方法,分析量表的内部一致性、条目间平均相关系数;总分与各因子间的相关系数、内容区分效度.临床诊断依据DSM-Ⅳ诊断标准中PTSD诊断标准确诊患者.采用受试者工作特征曲线计算曲线下面积和不同切割点下筛检PTSD的灵敏度、特异度及约登指数,以约臀指数最大的点为最佳切割点.结果 CRIES-13的Cronbach's α系数为0.903,条目间平均相关系数0.283～0.689.总分与各因子的相关系数0.836～0.868,各因子间的相关系数0.568～0.718;在总分、闯入、回避和高警觉因子评分方面,PTSD组均高于非PTSD组,差异有统计学意义(P<0.05).因子分析产生两个主成分,解释了总方差的59.68%,主要反映闯入症状和回避症状.汶川地震后7个月儿童PTSD的临床检出率为20.9%,男、女性PTSD患病率差异无统计学意义(P>0.05),CRIES-13以18分为切割点时筛检PTSD的约登指数最大,为57.6%,PTSD患者诊断预测的灵敏度为81.1%,特异度为76.5%,诊断效率81.1%.而选取32分切割点,筛查结果与临床诊断一致性较高(Kappa值=0.529).结论 CRIES-13在汶川地震后幸存儿童中具有良好的信、效度,可作为该群体一个较好的创伤后应激症状测评丁具.CRIES-13评分18分切割点可作为汶川地震后极重灾区中小学生筛检PTSD患者和确诊高危人群的切割点,而32分切割点筛检阳性率可初步预测灾后极重灾区中小学生PTSD患病率,此结论还有待于进一步研究证实.     

Diagnostic tests: distinguishing good tests from bad and even ugly ones.

This article focuses on the selection and interpretation of diagnostic tests, emphasizing the importance of understanding how their mathematical parameters affect the information they provide in various settings. The utility and limitations of sensitivity, specificity, predictive value, and receiver operating characteristic (ROC) curves are discussed using catheter-related bloodstream infections as an example. ROC curves have been used for selecting optimal cutoff values for a positive result and for selecting among several alternative diagnostic tests. For example, 16 different tests have been proposed for diagnosis of catheter-related bloodstream infection; ROC analysis provides an effective way to determine which test offers the best overall performance.     

Vaccination and HIV: a review of the literature

People with HIV are at risk for a variety of infections both at home and abroad. Recent studies have reported conflicting data concerning potential harmful effects following several inactivated vaccines. Antigenic stimulation by vaccines designed to prevent secondary infections may promote HIV-1 replication in certain patients. In HIV-positive subjects, immune response worsens with progression of the HIV infection. When vaccination is considered, administration of the vaccine must be performed as early as possible in the course of HIV infection because an HIV-infected patient's response to inactivated vaccines is closely related to HIV infection stage. A minority of subjects have a protective antibody response to vaccination. Consequently, specific antibody titers should be measured after vaccination to ensure immune protection. Immune response is improved by highly active antiretroviral therapy.Some live attenuated vaccines are considered as beneficial in some specific indications and if administered in the early stages of AIDS. However, viral load variations following administration of live attenuated vaccines have not been studied yet.