基于Logistic回归和受试者工作特征曲线评价6种血清标志物在鉴别胰腺肿物良恶性质中的临床价值  

Clinical value of six serum markers for differential diagnosis of pancreatic masses based on Logistic regression and ROC curve

作　　者：诸静文[1] 张洁 叶柳青[3] 丁金旺 陆军 李克桑 ZHU Jing-wen;ZHANG Jie;YE Liu-qing;DING Jin-wang;LU Jun;LIKe-sang(Department of Oncology,the Second Hospital of Ningbo,Ningbo,Zhejiang 315010,China)

机构地区：[1]宁波市第二医院肿瘤内科,浙江宁波315010 [2]西藏民族大学医学部基础医学院,陕西咸阳712082 [3]浙江省肿瘤医院检验科,浙江杭州310022 [4]杭州市第一人民医院/南京医科大学附属杭州医院肿瘤外科,浙江杭州310006 [5]杭州市第一人民医院/南京医科大学附属杭州医院肝胆外科,浙江杭州310006

出　　处：《中国卫生检验杂志》2019年第4期385-388,共4页Chinese Journal of Health Laboratory Technology

基　　金：国家自然科学基金青年项目(81602703);杭州市"131"人才计划

摘　　要：目的探讨基于Logistic回归和ROC曲线分析6种血清标志物联合检测在鉴别胰腺肿物良恶性质中的临床价值。方法检测并比较376例胰腺癌和256例良性胰腺肿物患者血清中CA19-9、CA50、CA242、CA125、 CEA和D-二聚体的表达差异,进一步联合Logistic回归和ROC曲线评价各血清标志物的诊断价值。结果胰腺癌患者血清中CA19-9、CA50、CA242、CA125、 CEA和D-二聚体的表达水平显著高于良性对照组,差异有统计学意义(均P<0.01)。相比Ⅰ期+Ⅱ期胰腺癌,Ⅲ期+Ⅳ期胰腺癌的血清CA19-9、CA50、 CA242、CA125、CEA和D-二聚体表达水平显著升高,差异有统计学意义(P<0.001)。单项检测时血清CA19-9、CA50、CA242、CA125、CEA和D-二聚体对鉴别胰腺肿物良恶性质的AUC分别为0.881、0.866、0.820、0.756、0.754、0.745;约登指数最大时,上述6项血清标志物的诊断敏感度分别为79.79%、65.96%、77.13%、56.38%、73.40%和60.64%,特异度分别为94.53%、93.75%、95.31%、84.38%、66.41%和87.50%。6项联合检测时,其鉴别胰腺肿物良恶性质的诊断效能优于各单一标志物检测,诊断AUC、敏感度和特异度分别为0.937、80.32%和95.31%。结论血清CA19-9、CA50、CA242、CA125、CEA和D-二聚体有助于鉴别胰腺肿物的良恶性质,联合检测可提高诊断效能,值得临床推广。Objective To explore the diagnostic value of serum CA19-9, CA50, CA242, CA125, CEA and D-dimer in differentiation of pancreatic mass based on a model of Logistic regression and ROC curve. Methods CA19-9,CA50,CA242,CA125, CEA and D-dimer in serum specimens from 376 pancreatic cancer patients and 276 patients with benign pancreatic masses were detected and compared. Logistic regression and ROC curve were used to evaluate the clinical diagnostic value of each index. Results The expression levels of serum CA19-9, CA50, CA242, CA125, CEA and D-dimer in pancreatic cancer group were significantly higher than those of control group, with the differences statistically significant(P<0.01). Also, the expression levels of serum CA19-9, CA50, CA242, CA125, CEA and D-dimer significantly increased in III-IV pancreatic cancer compared with I-II pancreatic cancer, with the differences statistically significant(P<0.001). For single assay, the AUC of serum CA19-9, CA50, CA242, CA125, CEA and D-dimer were 0.881, 0.866, 0.820, 0.756, 0.754 and 0.745. When the Youden index was the highest, the diagnostic sensitivity of above six serum markers was 79.79%, 65.96%, 77.13%, 56.38%, 73.40%, 60.64%, and the diagnostic specificity was 94.53%, 93.75%, 95.31%, 84.38%, 66.41% and 87.50%, respectively. For combination detection, the diagnostic value of serum CA19-9, CA50, CA242, CA125, CEA and D-dimer was better than any of them alone, with the AUC of 0.937, the sensitivity of 80.32%, and the specificity of 95.31%, respectively. Conclusion Serum CA19-9, CA50, CA242, CA125, CEA and D-dimer can help identify benign and malignant pancreatic tumors, and combined examination of the six serum markers can improve the diagnostic efficacy.

关 键 词：胰腺癌 肿瘤标志物 LOGISTIC回归 ROC曲线 诊断 

分 类 号：R735.9[医药卫生—肿瘤]