应用ROC曲线评价髓鞘碱性蛋白对多发性硬化的诊断价值  

Evaluation of myelin basic protein levels with receiver operating characteristic curves for diagnosis of multiple sclerosis

作　　者：田作军[1] 赵薛旭[2] 李作汉[2] 张帆[3] 曹福田[4] 李少明[1] 邵明[1] 董亚贤[1] 

机构地区：[1]广州医学院第一附属医院神经内科,广东广州510120 [2]南京脑科医院神经内科,江苏南京210029 [3]南京脑科医院检验科,江苏南京210029 [4]南京市中医院麻醉科,江苏南京210001

出　　处：《南方医科大学学报》2009年第2期250-252,共3页Journal of Southern Medical University

基　　金：广东省医学科研基金(A2007250)

摘　　要：目的运用受试者工作特征(ROC)曲线评价脑脊液(CSF)及血清中髓鞘碱性蛋白(MBP)诊断多发性硬化(MS)的价值。方法用ELISA法检测MS组(45例)患者CSF及血清中MBP水平,并与Guillain-Barre综合征(GBS)组(36例)及对照组(33例)相比较。运用ROC曲线评价CSF及血清中MBP诊断MS的敏感性及特异性。结果MS组中CSF和血清中MBP水平均显著高于GBS组(P<0.01)及对照组(P<0.01)。CSF中MBP诊断MS的ROC曲线下面积(AUC)为0.853±0.037,最佳分界值为0.87pg/ml。以CSF中MBP≥0.87pg/ml来预测MS,敏感性为83.7%,特异性为78.3%。血清MBPROC曲线的AUC为0.761±0.046,最佳分界值为0.25pg/ml。以血清MBP≥0.25pg/ml来预测MS,敏感性为62.8%,特异性为73.9%。两条曲线AUC的未达统计学差异(P>0.05)。结论CSF及血清MBP水平对诊断MS均有一定的准确性,两者联合可以作为诊断MS较为敏感的指标,CSF中MBP比血清MBP敏感性更高。Objective To assess the value of cerebral spinal fluid （CSF） and serum myelin basic protein （MBP） levels in the diagnosis of multiple sclerosis （MS）. Methods Enzyme-linked immunosorbent assay was used to detect the CSF and serum levels of MBP in patients with MS （n=45）, patients with Guillain-Barre syndrome （GBS） （n=36） and control subjects （control） （n=33）. The sensitivity and specificity of MBP in CSF and serum in the diagnosis of MS were evaluated using the receiver-operating characteristic （ROC） curves. Results The MBP levels in CSF and serum both increased significantly in MS group as compared with those in GBS （P〈0.01） and control groups （P〈0.01）. The area under the curve （AUC） of the ROC curve of MBP in CSF was 0.853±0.037 for MS diagnosis, and with the optimal cut-off value of 0.87 pg/ml, CSF MBP showed a diagnostic sensitivity of 83.7% and spectificity of 78.3%. The AUC of the ROC curve of serum MBP was 0.761±0.046, and the optimal cut-offvalue of 0.25 pg/ml resulted in a diagnostic sensitivity of 62.8% and spectificity of 73.9%. No statistically significant difference was found between the two AUCs （P〉0.05）. Conclusion Evaluation of CSF and serum MBP levels allows accurate diagnosis of MS, and MBP level in the CSF has greater diagnostic sensitivity than serum MBP. The combination of both CSF and serum MBP levels may serve as a sensitive index for the diagnosis of MS.

关 键 词：多发性硬化 脑脊液 血清 髓鞘碱性蛋白 ROC曲线 

分 类 号：R744.51[医药卫生—神经病学与精神病学]