鹿児島市学校心臓検診スクリーニングシステム精度の検討

Junpei Kawamura; 川村順平; Yuichi Nomura; 野村裕一; Naohiro Shiokawa; 塩川直宏; Daisuke Hazeki; 櫨木大祐; Kentaro Ueno; 上野健太郎; Yuji Tanaka; 田中裕治; Kiminori Masuda; 益田君教; Makoto Nishibatake; 西畠信; Masao Yoshinaga; 吉永正夫

doi:10.9794/jspccs.37.96

鹿児島市学校心臓検診スクリーニングシステム精度の検討High Accuracy of School-Based Cardiovascular Screening System in Kagoshima City

川村順平^1,2，野村裕一^1,3，塩川直宏^1,2，櫨木大祐^1,2，上野健太郎^1,2，田中裕治^1,4，益田君教^1,3，西畠信^1,5，吉永正夫^1,4Junpei Kawamura^1,2, Yuichi Nomura^1,3, Naohiro Shiokawa^1,2, Daisuke Hazeki^1,2, Kentaro Ueno^1,2, Yuji Tanaka^1,4, Kiminori Masuda^1,3, Makoto Nishibatake^1,5, Masao Yoshinaga^1,4

¹ 鹿児島市学校心臓検診委員会Committee on the School-Based ECG Screening Program of Kagoshima City ◇ Kagoshima, Japan

² 鹿児島大学病院小児科Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences ◇ Kagoshima, Japan

³ 鹿児島市立病院小児科Department of Pediatrics, Kagoshima City Hospital ◇ Kagoshima, Japan

⁴ 鹿児島医療センター小児科National Hospital Organization Kagoshima Medical Center ◇ Kagoshima, Japan

⁵ 総合病院鹿児島生協病院小児科Department of Pediatrics, Kagoshima Seikyo Hospital ◇ Kagoshima, Japan

受付日：2020年12月3日Received: December 3, 2020

受理日：2021年1月14日Accepted: January 14, 2021

発行日：2021年8月1日Published: August 1, 2021

背景：鹿児島市の学校心臓検診（心検）の1次検診は医師6～8名の判読後に集団討議で抽出例を絞り込む集団判読が特徴である．本心検の精度を検討した．

方法： 1989年から30年間の小・中学校心検受診者67,723例を対象とし，2次抽出例の割合（抽出率）と全対象内の心検で診断された有疾患例の割合（心検有病率）と既診断例も含めた全有疾患例の割合（総有病率）を解析した．

結果：年度毎の抽出率は12誘導心電図が導入された1994年以降で，集団判読導入の2001年以前は2.4％ [1.9–3.0％]（中央値［範囲］）で導入後は1.5％ [1.2–2.2％］であり，有意に低値だった．しかし，集団判読導入後の心検有病率は1994年から2000年の期間と比較して有意に高率だった（43％ [33–50％] vs. 28％ [26–35％]）．総有病率は0.60％ [0.50–0.85％］だった．

結論：当市心検の抽出率は全国（3.0％）より低いが，総有病率は全国（0.9％）に近く十分な精度だった．この精度の維持は，12誘導心電図の導入に加えて集団判読の効果と考えられた．

Background: A school-based cardiovascular (CV) screening in Kagoshima City is characterized by a group discussion system. Pediatric cardiologists discuss whether electrocardiograms (ECGs), screened by a cardiologist, should be referred for the second examination. Here, we examined the accuracy of the screening system in Kagoshima City.

Methods: Subjects comprised 67,723 elementary and junior high school students who underwent the screening between 1989 and 2018. In Kagoshima City, the standard 12-lead ECG recording at the first screening was started in 1994, and the group discussion system was introduced in 2001. We analyzed the rate of the first ECG screening, the rate of patients with CV diseases through the screening, and the rate of patients with CV diseases, including those already diagnosed (total prevalence).

Results: The rate of the first screening after the group discussion system (1.5％ [1.2–2.2％] (median [range])) was significantly lower than that before the system (2.4％ [1.9–3.0％]). The CV disease rate through the screening between 2001 and 2018 was significantly higher than that between 1994 and 2000 (43％ [33–50％] vs. 28％ [26–35％]). The total CV disease rate was 0.60％ [0.50–0.85％].

Conclusions: The accuracy of the screening system in Kagoshima City was sufficiently high because the total CV disease rate was similar to that of the national average (0.9％), although the first screening rate was lower than that of the national average (3.0％). The group discussion system might support this high accuracy in addition to the use of 12-lead ECGs.

Key words: accuracy; double check; group discussion; school-based screening; primary screening

日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

原著Original

鹿児島市学校心臓検診スクリーニングシステム精度の検討High Accuracy of School-Based Cardiovascular Screening System in Kagoshima City