ROC曲线在多项指标鉴别胸腹腔积液性质中的应用  

Application of ROC Curve in Diagnosis of Pleural Effusion and Ascites with Multiple Parameters

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：《现代检验医学杂志》2006年第5期25-27,共3页Journal of Modern Laboratory Medicine

摘　　要：目的应用ROC曲线探讨胸腹腔积液中多项指标并探讨对胸腹腔积液性质的鉴别价值。方法收集138例患者的胸腹腔积液和血清,同步测定清蛋白(ALB)及其浓度梯度(AG),乳酸脱氢酶(LDH)及其比值,癌胚抗原(CEA)及其比值,腺苷脱氨酶(ADA)及其比值,通过ROC曲线分析临床性能,并确定最佳临界值。结果恶性胸腹腔积液的各指标的最佳临界值分别为:AG≤11.0 g/L,胸腹腔积液LDH≥185.6 U/L,LDH比值≥0.92,胸腹腔积液CEA≥7.0 ng/m l,CEA比值≥1.04。ROC曲线下面积分别为0.809,0.849,0.828,0.843,0.732。结核性胸腹腔积液的各指标的具体临界值:AG≤10.5 g/L,胸腹腔积液LDH≥180.0 U/L,LDH比值≥0.94,胸腹腔积液ADA≥37.74 U/L,ADA比值≥1.11。ROC曲线下面积分别为0.776,0.797,0.849,0.936,0.932。结论单个指标有一定的局限性,只有综合利用多项检测指标来对病人作出诊断,才能提高诊断的准确性。运用ROC曲线分析可确定各项检测指标的临界值,科学地服务于临床。Objective To apply ROC curve to investigate the value of multiple parameters in diagnosis of pleural effusion and ascites. Methods The contents of albumin,LDH,CEA and ADA were determ;ned in 138 cases of pleural effusion or ascites and their serum. Meanwhile the albumin gradient （AG）and the respective ratio of LDH,CEA and ADA of pleural effusion or ascites to serum were calculated. ROC curve was used to analyze the clinical properties and determine the optimal limit values. Result The optimal limit values of these parameters for differentiation of malignance and non-malignance were as follows：AG≤11.0 g/L,LDH（in pleural effusion or ascites）≥185.6 U/L,LDH ratio≥0.92,CEA（in pleural effusion or ascites）≥7.0 ng/ml ,CEA ratio≥1. 04. The under-ROC curve areas of the above parameters were respectively 0. 809,0. 849,0. 828.0. 843 and 0. 732. The optimal limit values for diagnosis of tuberculous pleural effusion or ascites were as follows ：AG≤10.5 g/L ,LDH（in pleural effusion or ascites）≥180. 0 U/L ,LDH ration≥0.94 ,ADA（in pleural effusion or ascites）≥37.74 U/L,ADA ratio≥1. 11. The under-ROC curve areas of these parameters were respectively 0. 776,0. 797, 0. 849,0. 936 and 0. 932. Conclusion As only one single parameter is inadequate,comprehensive application of multiple parameters can improve the veracity of diagnosis. ROC curve can be used to determine the optimal limit values and serve the clinic scientifically.

关 键 词：胸腹腔积液 清蛋白梯度 乳酸脱氢酶 癌胚抗原 腺苷脱氨酶 ROC曲线 

分 类 号：R446.19[医药卫生—诊断学] R447[医药卫生—临床医学]