Logistic回归和ROC曲线综合分析组合项目对胸腹水性质的鉴别价值  

Application of Logistic Regression and ROC Curve in Differentiation between Pleural Effusion and Ascite

作　　者：鄢斌[1] 刘军[1] 李承彬[1] 李俊立[1] 王昌富[1] 

机构地区：[1]华中科技大学同济医学院附属荆州医院检验医学部,湖北荆州434020

出　　处：《中国误诊学杂志》2006年第15期2876-2879,共4页Chinese Journal of Misdiagnostics

基　　金：2005年荆州市科技攻关项目(编号:2005RPE01-6)

摘　　要：目的:建立并运用数学模型来定量探讨胸腹水中不同项目组合联合检测对胸腹水性质的鉴别价值。方法:收集本院138例胸腹水患者的胸腹水和血清,同步测定胸腹水、血清白蛋白(ALB)及其浓度梯度(AG),胸腹水、血清乳酸脱氢酶(LDH)及其比值,胸腹水、血清癌胚抗原(CEA)及其比值,胸腹水、血清腺苷脱氨酶(ADA)及其比值,采用Lo-g istic逐步回归,筛选鉴别诊断胸腹水性质中的相关指标,对不同组合进行综合分析。通过ROC曲线分析临床性能,最后得相应的数学模型即回归方程。结果:AG、胸腹水LDH、胸腹水CEA三项指标运用回归方程P1=1/[1+-e(-2.083-0.147X 1+0.006X 2+0.121X 3)]综合分析鉴别恶性胸腹水,其灵敏度、特异性、准确性分别为87.5%、86.8%、87.0%。AG、LDH比值、胸腹水ADA、ADA比值四项指标运用回归方程P2=1/[1+-e(-5.607-0.089X 1+0.366X 2+0.078X 3+1.564X 4)]综合分析判断结核性胸腹水,其灵敏度、特异性、准确性分别为90.9%、88.6%、89.1%。结论:运用Log istic回归和ROC曲线综合分析不同项目组合联合鉴定胸腹水的性质,大大提高了诊断的科学性、准确性。Objective：To establish a mathematic model to explore the differentiation between pleural effusion and ascite. Methods ：The concentrations of albumin,LDH,CEA and ADA in pleural effusion or ascite and sera in 138 patients were determined. Meanwhile the albumin gradient （AG） and the respective ratios of LDH,CEA and ADA of pleural effusion or ascite to serum were calculated. After analyzing the data with logistic regression the useful items were selected, and different comparisons were performed. Results： According to the regression equation： P1=1/[1＋e^-（-2.083-0.147X1＋0.006X2＋0.121X3）] ,the sensitivity,specificity and veracity of the combination of AG、LDH and CEA in pleural effusions and ascites were 87.5 %, 86.8 % and 87.0% ,respectively in diagnosis of malignance and non-malignance. The sensitivity,specificity and veracity of the combination of AG,LDH ratio,ADA ratio and ADA in pleural effusions and ascites in diagnosis of tuberculous according to the regression equation P2=1/[1＋e^-（-5.607-0.089X1＋0.366X2＋0.078X3＋1.564X4）] and were 90. 9 %, 88. 6% and 89.1%, respectively. Conclusion：It was scientific and accurate to diagnose pleural effusions and ascites with the mathematic model deduced from logistic regression and the cut-off value calculated by ROC curve method.

关 键 词：胸腔积液/诊断 腹水/诊断 LOGISTIC模型 ROC曲线 综合分析 

分 类 号：R446.142[医药卫生—诊断学]