病史和体检是否有助于确定刺激性肠综合征是导致这个患者下胃肠道症状的原因?
Alexander C Ford1, Nicholas J Talley, Sander J O Veldhuyzen van Zanten
1Gastroenterology Division, McMaster University Medical Centre, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada. alexf12399@yahoo.com
JAMA
|October 16, 2008
概括
个别症状对诊断易怒肠综合征 (IBS) 的准确性有限. 虽然罗马一号标准显示出一些有效性,但曼宁和克鲁斯标准对于IBS诊断的准确性只有适度.
科学领域:
- 胃肠病学 胃肠病学
- 临床诊断 临床诊断 临床诊断
- 基于证据的医学是基于证据的医学.
背景情况:
- 下胃肠道症状很常见,通常归因于功能条件.
- 刺激性肠综合征 (IBS) 是一个基于症状的常见诊断.
- 在IBS诊断之前,一些患者需要进一步调查.
研究的目的:
- 系统地审查有关IBS个体症状和症状组合的诊断准确性的文献.
- 评估不同诊断标准在识别IBS时的有效性.
主要方法:
- 在2008年6月之前对MEDLINE和EMBASE的系统文献搜索.
- 包括对患有下胃肠道症状的成年患者的前性研究.
- 由两位作者独立提取数据和概率比 (LR) 估计.
主要成果:
- 分析了10项涉及2355名患者的研究,其中IBS患病率为57%.
- 个体症状显示的诊断值有限 (阳性LRs 1.2-2.1).
- 罗马I标准 (LR 4.8) 和Kruis评分 (LR 8.6) 的准确性比曼宁标准 (LR 2.9) 更好.
结论:
- 在患有下部胃肠道症状的患者中,个人症状对诊断IBS的准确性较低.
- 曼宁标准和Kruis评分系统显示了适度的准确性.
- 只有罗马I标准得到了验证;需要进一步的研究来改进IBS诊断方法.
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