应用ROC曲线评价生化指标对肝硬化的诊断价值  

Effect of ROC curves in evaluation of biochemical markers for diagnosing hepatocirrhosis

作　　者：张洁[1] 王琨[1] 熊立凡[1] 

机构地区：[1]上海交通大学医学院附属仁济医院检验科,上海200001

出　　处：《诊断学理论与实践》2007年第4期299-303,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:运用受试者工作特征(ROC)曲线评价肝硬化辅助诊断的生化指标。方法:对133例肝病患者(肝硬化90例,慢性肝病43例)和28名健康对照组生化指标如血清白蛋白(ALB)、丙氨酸氨基转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆汁酸(TBA)、γ-谷氨酰转肽酶(GGT)、总胆红素(TBIL)、α2-巨球蛋白(α2M)、结合珠蛋白(HPT)、载脂蛋白A1(apoA1)进行检测。采用ROC曲线评价各指标的灵敏度(sensitivity,SEN)和特异度(specificity,SPE),并分析多指标联合检测的诊断效率。结果:临床常规鉴别诊断肝硬化与慢性肝病的指标ALB、ALT、AST、TBA、GGT、TBIL、α2M、HPT、apoA1,其单项检测的灵敏度分别为88.9%、65.6%、80.0%、68.9%、57.8%、58.9%、83.3%、53.3%、73.3%;特异度为90.7%、53.5%、51.2%、81.4%、62.8%、81.4%、27.9%、88.4%、90.7%;ROC曲线下面积(AUC)为0.947、0.565、0.659、0.774、0.591、0.690、0.570、0.700、0.860。其中,ALB、AST、TBA、TBIL、HPT、apoA1这6项指标在肝硬化组和慢性肝病组间有显著差异(P<0.05)。ALB、TBA、HPT、apoA1这4项指标平行试验的灵敏度为99.4.%,特异度为59.0%,阴性似然比为0.01,诊断准确度为89.5%;而4项指标系列试验的灵敏度为24.8%,特异度为99.9%,阳性似然比为248,诊断准确度为56.4%。结论:ALB、TBA、HPT、apoA14项指标的平行试验可作为排除肝硬化的诊断试验,系列试验可作为确诊肝硬化的较好指标。Objective To assess regular serum parameters for diagnosis of liver cirrhosis with ROC curves.Methods A total of 9 serum markers,including albumin（ALB） ,alanine aminotransferase（ALT） ,aspartate aminotransferase（AST） ,total bile acid（TBA） ,gamma-glutamyltransferase（GGT） ,total bilirubin（TBIL） ,α2-macroglobulin（α2-MG） ,haptoglobin（HPT） and apoprotein A1（apoA1） ,were assessed in 90 patients with liver cirrhosis and 43 patients with chronic liver disease.The sensitivity and specificity of all the tests were evaluated by receiver operating characteristics curve（ROC curve） .Results The areas under ROC curve were 0.947 in ALB,0.565 in ALT,0.695 in AST,0.774 in TBA,0.591 in GGT,0.690 in TBIL,0.570 in α2-MG,0.700 in HPT and 0.860 in apoA1 respectively in the differential diagnosis between liver cirrhosis and chronic liver disease.The sensitivities were 88.9% in ALB,65.6% in ALT,80.0% in AST,68.9%in TBA,57.8% in GGT,58.9% in TBIL,83.3% in α2-MG,53.3% in HPT and 73.3% in apoA1,respectively and the specificities were 90.7%（ALB） ,53.5%（ALT） ,51.2%（AST） ,81.4%（TBA） ,62.8%（GGT） ,81.4%（TBIL） ,27.9%（α2-MG） ,88.4%（HPT） ,90.7%（apoA1） respectively.Only ALB,AST,TBA,TBIL,HPT and apoA1 had statistical significant difference（P〈0.05） between the liver cirrhosis and the chronic liver disease.With four markers of ALB,TBA,HPT and apoA1 in parallel test,their sensitivity was 99.4%,specificity 59.0%,negative likelihood ratio 0.01,and diagnostic accuracy 89.5%.With the four makers in serial test,their sensitivity was 24.8%,specificity 99.9%,positive likelihood ratio 248,and diagnostic accuracy 56.4%.Conclusions Combined test of ALB,TBA,HPT and apoA1 has higher value in diagnosing the liver cirrhosis.

关 键 词：肝硬化 ROC曲线 联合检测 阴性似然比 阳性似然比 

分 类 号：R446.1[医药卫生—诊断学]