sadiagnostiko testis

sandoobis Sefaseba

mgrZnobeloba, specifiuroba,
prognozuli Rirebuleba
 daavadebis aprioruli albaTobis
Sefaseba

daavadebis dadasturebis an
gamoricxvis TvalasazrisiT
mniSvnelovania sadiagnostiko
testis sandoobis Sefaseba, rac
xdeba meTodis etalonTan
SedarebiT.
 Ddiagnostikuri meTodebis
Sefaseba
• Ddiagnostikis yvela meTodi gansxvavdeba
sizustis sxvadasxva xarisxiT

• Aarsebuli meTodebidan yvelaze zustia

«oqros standarti» anu referentuli
diagnostikuri testi.

• im SemTxvevaSi, rodesac ar arsebobs

sando referentuli testi, gamoiyeneba
daavadebis diagnostikuri kriteriumebi
 revmatiuli cxelebis sadiagnostikod gamoiyeneba
jonsis kriteriumebi (1956w., ganaxlebuli 2002 w.)

dadasturebuli revmatiuli cxeleba - ori didi an erTi didi

da ori mcire kriteriumi da dadasturebuli streptokokuli
infeqcia

didi kriteriumebi: mcire kriteriumebi:

• karditi; • cxeleba
• arTralgia
• poliarTriti;
• revmatiuli cxeleba an
• qorea; gulis revmatiuli
• rgoliseburi eriTema daavadeba anamnezSi.
• mwvave fazaSi - eds-is da
• kanqveSa kvanZebi. C reaqtiuli cilis
• ekg– momateba
gaxangrZlivebuli PR • eleqtrokardiogramaz
intervali
 diagnostikuri testis
xarisxi
•testi unda iyos iafi
•praqtikulad gamosayenebeli
•advilad aRwarmoebadi
•iZleodes Sedegebis martivi
interpretaciis saSualebas
 testis Sedegebi
xSir SemTxvevaSi Sedegebi Tanxvdeba
oqros standarts da es Tanxvedra
WeSmaritad dadebiTia, (daavadeba aris
da testi mas adasturebs), an WeSmaritad
uaryofiTia (daavadeba ar aris da
testi mas uaryofs) Sedegebi SeiZleba
iyos cru uaryofiTi (daavadeba aris,
magram testi mas uaryofs) an cru
dadebiTi (daavadeba ar aris da testi
mas adasturebs)
 Tanafardoba testis
Sedegsa da daavadebas Soris
daavadeba daavadeba ar
aris aris

testi а– b – cru
dadebiTia WeSmaritad dadebiTi
dadebiTi

testi с – cru d-
uaryofiTia uaryofiTi WeSmaritad
uaryofiTi
 diagnostikuri testis
maxasiaTeblebi

testis а/(а+с) = WeSmaritad

mgrZnobeloba dadebiTi testebis wili
avadmyofebs Soris

testis d/(b+d) = WeSmaritad

specifiuroba uaryofiTi testebis wili
janmrTelebs Soris
 diagnostikuri testis
maxasiaTeblebi
testis mgrZnobeloba testis specifiuroba
(Sensitivity) (Specificity)
ewodeba ewodeba diagnostikuri
diagnostikuri testis uaryofiTi
testis dadebiTi Sedegis albaTobas
Sedegis albaTobas
daavadebis
daavadebis
arsebobisas ararsebobis
SemTxvevaSi
 testis operaciuli
maxasiaTeblebi

• cru uaryofiTi • cru dadebiTi

Sedegebis maRali Sedegebis maRali
sixSiris gamo sixSiris gamo
avdmyofi janmrTeli
fiqsirdeba, fiqsirdeba,
rogorc rogorc avadmyofi
janmrTeli

saukeTeso testi aris maRalspecifiuri da maRalmgrZnobiare

 testis SedegisSemTxvevaSi saWiroa
dadgindes: adamiani aris janmrTeli
Tu avadmyofi

testis prognozuli Rirebuleba

ewodeba daavadebis arsebobis
albaTobas testis cnobili
Sedegis mixedviT
igi damokidebulia:
•Ddiagnostikuri testis
sizusteze
•Ddavadebis gavrcelebaze
 dadebiTi а/(а+b) = WeSmaritad
testis dadebiTi testebis wili
prognozuli yvela dadebiT tests
Rirebuleba Soris

uaryofiTi d/(c+d) = WeSmaritad

testis uaryofiTi testebis wili
prognozuli yvela uaryofiT tests
Rirebuleba Soris
meTodis (a+d)/(a+b+c+d) =
diagnosti- WeSmariti Sedegebis wili
kuri sizuste testis yvela Sedegs
Soris
testis prognozuli
Rirebulebis (PPV) damokidebuleba
gavrcelebaze

PV = mgrZnobelobaxgavrceleba
(mgrZnob.xgavrcel.)+(1-spec.)x(1-gavrc.)

rac ufro maRalia

prognozuli Rirebuleba,
miT ufro xelsayrelia
testi !!!
• rac ufro mgrZnobiarea
testi, miT maRalia
uaryofiTi Sedegis
prognozuli Rirebuleba
• rac ufro specifiuria
testi, miT maRalia
dadebiTi Sedegis
prognozuli Rirebuleba
 albaTobaTa fardoba
dadebiTi Sedegis albaTobaTa fardoba
gviCvenebs, ramdenad mosalodnelia
WeSmaritad dadebiTi Sedegis miReba cru
dadebiTTan SedarebiT

uaryofiTi Sedegis albaTobaTa

fardoba gviCvenebs, ramdenad
mosalodnelia WeSmaritad
uaryofiTi Sedegis miReba cru
uaryofiTTan SedarebiT
 sadiagnostiko testis
Sefaseba
albaTobaTa fardoba
mniSvnelovania >10 an <0,1
saSualo 5 - 10 an 0,1 - 0,2
umniSvnelo 2 - 5 an 0,5 - 0,2
mcire 0,5 – 2
rac metia albaTobaTa fardoba,
miT ufro sandoa testi
 testis Sefaseba
magaliTi: (Se=99%, Sp=93%):

1. gavrceleba = 10%, PPV = 58%

2. gavrceleba = 50%, PPV = 93%
3. gavrceleba = 1%, PPV = 12,5%
Dtesti raodenobrivi SedegiT
• testis raodenobrivi Sedegis
Sesafaseblad unda dadgindes
gamyofi zRvari

gamyofi zRvari ewodeba

maxasiaTeblis sidides,romelic
ganasxvavebs avadmyofebs
janmrTelebisgan.
 ROC mrudi
• diagnostikuri testis
efeqturobis Sefasebis yvelaze
Tanamedrove da srulyofili
meTodia maxasiaTebeli ROC
mrudis
ageba
• igi gansazRvravs damokide-
bulebas mgrZnobelobas (Se) da
(1- Sp) Soris
 testis informatiulobis
mgrZnobeloba
gansazRvra

1-specifiuroba
 maxasiaTebeli mrudi ROC
(receiver operator characteristic)
• testis informatiulobas
gansazRvravs mrudis qvemoT
arsebuli farTobi.
• rac ufro uaxlovdeba farTobi
kvadratis farTobs miT ufro
efeqturia testi
• rac ufro uaxlovdeba mrudi
diagonals miT naklebad efeqturia
testi
 testis maxasiaTeblebis
Sefaseba
• sizustis Sefaseba xdeba
sarwmunoebis intervalis
saSualebiT. intervalis
diapazoni gansazRvravs
sizustis Sefasebis xarisxs.
• rac metia pacientTa raodenoba,
miT viwroa sarwmunoebis
intervali da Sesabamisad metia
sizuste
 diagnostikuri testis
gamoyenebis saxeebi
• skriningi (screening)– populaciaSi
daavadebul pirTa gamovlenis
mizniT Catarebuli kvleva
• Tanamdevi daavadebis gamovlena
(case finding).
Catarebuli kvleva (mag. rutinuli
klinikur-
laboratoriuli kvleva)
 diagnostikuri testis
gamoyenebis saxeebi
• diagnostikuri kvleva -
CivilebiT misuli
avadmyofisTvis diagnozis
dasazusteblad Catarebuli
kvleva
• monitoringi – mkurnalobis
efeqturobis dasadgeni kvleva