急性弛缓性麻痹监测筛检指标的探讨

戴振威; 刘宏杰; 沈永刚; 刘丹青; 陈晓琴; 余文周

Abstract

戴振威,刘宏杰,沈永刚,刘丹青,陈晓琴,余文周.急性弛缓性麻痹监测筛检指标的探讨[J].Chinese journal of Epidemiology,1996,17(3):136-138

急性弛缓性麻痹监测筛检指标的探讨

Criterion on the Screening for Acute Flaccid Paralysis (AFP) Surveillance

Received:November 15, 1995 Revised:December 10, 1995

DOI：

KeyWord: 急性弛缓性麻痹监测筛检指标

English Key Word: Acute flaccid paralysis(AFP) Surveillance Screening criterion

FundProject:

Author Name	Affiliation
Dai Zhen-wei	Anhui Provincial Anti-Epidemic Station, Hefei 230061
Liu Hong-jie	Anhui Provincial Anti-Epidemic Station, Hefei 230061
Shen Yong-gang	Anhui Provincial Anti-Epidemic Station, Hefei 230061
刘丹青	Anhui Provincial Anti-Epidemic Station, Hefei 230061
陈晓琴	Anhui Provincial Anti-Epidemic Station, Hefei 230061
余文周	Anhui Provincial Anti-Epidemic Station, Hefei 230061

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Abstract:

以15岁以下的儿童发生不明原因的急性弛缓性麻痹(简称"AFP")为监测对象筛检脊灰,虽保持着高的灵敏度,但不具有特异度,假阳性率很高。为找出特异性高、操作性强的筛检指标,我们对1991年全省发生的818例AFP病例进行研究。
在818例AFP中,脊灰和非脊灰AFP好发于5岁以下年龄组;87.63%的脊灰病例在发病早期有发热症状,而非脊灰AFP为45.99%。以年龄和发病早期有发热史为指标做筛检试验,并联试验中,灵敏度很高,但特异度仍然很低;用5岁以下(包括5岁)年龄组和发病早期有发热史做串联试验,其灵敏度为81.44%,特异度为65.54%,从ROC曲线上看,把指标定在这里较为理想。从卫生经济角度考虑、着眼于实际工作,对AFP病例开展监测,其对象应为5岁以下儿童,同时伴有早期发热者应视为脊灰高危人群,作为"第一重点"处理。

English Abstract:

Using AFP as the criterion for surveillance of children aged<15 years on polio eradication programme, the sensitivity is 100%. But specificity is low, with high false positivity. Through analysing all 818 cases of AFP occurred in 1991 in Anhui province,we were trying to find out a more specific criterion for the purpose of screening polio cases from AFP.
Among 818 cases of AFP aged< 15 years, most polio and non-polio AFP cases occurred under 5 years. At the onset of paralysis, 87.63% of the polio cases presented with fever, compared with 45.99% of non-polio AFP cases did. There fore we chose age and fever at the onset of paralysis as the criterion for screening tests. In parallel tests, the sensitivity was very high, but the specificity was still low. In serial tests, the combination of age under< 6 and fever at onset of paralysis resulted in a sensitivity of 81.44% and specificity of 65.54%. This results suggested that by screening the cases of AFP aged< 6 years who had fever at the onset of paralysis, the number of sample size under testing can he largely reduced, with a minimal compromise in the sensitivity. As for surveillance purpose, the criterion can be used to identify more critical cases followed by urgent attention.

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