应用ROC曲线建立儿童外科感染预测模型的研究  

Evaluation of children's surgery infection prediction with C reactive protein by using ROC analysis

作　　者：李波[1] 吴建国[2] 廖兵[2] 谢义民[2] 

机构地区：[1]重庆三峡中心医院儿童分院检验科,404000 [2]重庆三峡中心医院儿童分院儿外科,404000

出　　处：《国际检验医学杂志》2010年第11期1231-1233,共3页International Journal of Laboratory Medicine

摘　　要：目的采用受试者操作特性曲线(ROC)评价C反应蛋白(CRP)对儿童外科感染的发生的预测价值。方法根据临床转归结果分组,对276名该院儿童外科患者分别逐日记录其住院期间的CRP、白细胞(WBC)水平及中性粒细胞比例(N%)进行ROC分析。结果各组患者感染比例由小到大依次为:未手术、Ⅰ类切口、Ⅱ类切口、Ⅲ类切口(P<0.01)。各组感染患者住院时间均长于无感染患者(P<0.01)。各组患者CRP、WBC拐点出现时间均在感染确诊前(P<0.01),中性粒细胞比例(N%)拐点时间与感染确诊时间无显著差异(P>0.05)。各组中感染组术后CRP的拐点值大于未感染组(P<0.01)。经ROC分析,术后CRP峰值达到32.7mg/dL以上的患儿存在较大的术后感染风险(P<0.01,预测敏感性为88.4%,特异性为94.4%)。并将ROC分析结果应用ACCESS数据库编程的方式,建立儿童术后感染的早期预测模型。结论术后CRP拐点值作为独立预测感染发生概率的指标较WBC及中性粒细胞比例有更高的敏感性和特异性,且CRP拐点出现时间早于后述两指标,使预测结果对于患者的及时救治有更积极的意义。数据编程的应用为模型的使用及大样本量数据的搜集提供了可能。Objective To evaluate the prediction of children surgery infection with C reactive protein by using ROC analysis. Methods C reactive protein （CRP）,white blood cells （WBC） and neutrophils ratio （N%） were investigated daily in 276 children surgery patients during hospitalization period. ROC analysis was made basing on clinic outcomes. Results Infection incidences were lining up as non-surgery 〈 type I incision 〈 type II incision 〈 type III incision （P〈0.01）. Hospitalization time was significantly longer in all infection groups than in correspondent non-infection groups （P〈0.01）, respectively. Inflection point of CRP and WBC appeared before infection was confirmed （P〈0.01） in all groups, while the inflection point of N% not. The inflection point value was significantly higher in all infection groups than in correspondent non infection groups （P〈0.01）, respectively. ROC analysis showed that children with CRP peak over 32.7 mg/dL after surgery had significantly higher infection risk （P〈0.01,sensitivity 88.4 %, specificity 94.4%）. Conclusion Infection is a common complication of children surgery,and its incidence is associated with incision type. Hospitalization time will be prolonged once infection happens. It has higher sensitivity and specificity than either WBC or N% using the inflection point of CRP as an independent index of infection incidence. Moreover,as the inflection point of CRP appears earlier than both WBC and N%,children patients can be treated promptly after infection happens by using CRP to diagnose infection.

关 键 词：C反应蛋白质 ROC曲线 儿童 外科手术 感染 预测 

分 类 号：R726.5[医药卫生—儿科]