ROC曲线评价血清半乳甘露聚糖检测侵袭性曲霉菌病的诊断价值  

Evaluate the diagnostic value of serum galactomannan antigen assay for invasive aspergillosis with ROC curve

作　　者：张凤川[1] 黎结霞 王露霞[3] 石凌波[4] 成德 

机构地区：[1]广州军区联勤部门诊部检验科,广东广州510080 [2]中山大学附属第三医院检验科,广东广州510630 [3]广州军区广州总医院检验科,广东广州510010 [4]广州中医药大学祈福医院检验科,广东广州511495 [5]西藏拉萨娘热路自治区藏医院检验科,西藏拉萨850000

出　　处：《热带医学杂志》2014年第8期1049-1052,共4页Journal of Tropical Medicine

摘　　要：目的利用ROC曲线评价血清半乳甘露聚糖(GM)抗原检测试验对侵袭性曲霉菌病(IA)早期感染的诊断价值,并提供合理的阳性界值。方法根据诊断标准回顾性地将576例患者分为IA非感染组和IA感染组,其中IA感染组又分为确诊、临床诊断、拟诊、确诊+临床诊断、确诊+临床诊断+拟诊5组,分别作ROC曲线,分析各组的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、ROC曲线下面积,确定阳性界值。结果 576例患者中IA非感染组336例,IA感染组240例,包括确诊4例、临床诊断30例、拟诊206例。确诊组、临床诊断组、拟诊组、确诊+临床诊断组、确诊+临床诊断+拟诊组ROC曲线下面积分别为0.966、0.797、0.757、0.817、0.765,阳性界值分别为0.9、0.5、0.6、0.5、0.6,NPV分别为100.0%、98.6%、79.3%、98.6%、77.5%,PPV分别为9.3%、18.0%、60.1%、20.1%、64.2%。结论血清GM抗原检测试验对IA具有早期诊断价值,合理运用不同的GM阳性界值有助于临床IA分型诊断。Objective To evaluate the diagnostic value of serum galactomannan（GM） antigen assay for invasive aspergillosis（IA） with receiver-operating characteristic curve（ROC）, and provide a reasonable cut-off. Methods All cases were classified as two parts with IA infection and without IA infection according to the criteria of invasive fungal infections in China. Then the part with IA infection was classified as five groups including proven, probable, possible, proven＋probable and proven＋probable＋possible. Furthermore the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV）,area under curve（AUC） and the best cut off value by ROC curve were analyzed. Results Of the 576 patients, there were 4proven cases, 30 probable cases, 206 possible cases, and 336 cases without infection. AUC of proven group, probable group,possible group, proven＋probable group and proven＋probable＋possible group were 0.966, 0.797, 0.757, 0.817 and 0.765,respectively, with the cut-off values（I） of 0.9, 0.5, 0.6, 0.5, and 0.6, respectively, NPV of 100.0%, 98.6%, 79.3%, 98.6%,and 77.5%, respectively, and PPV of 9.3%, 18.0%, 60.1%, 20.1%, and 64.2%, respectively. Conclusion Serum GM antigen detection was an effective method for early diagnosis of IA. The rational use of GM cut-off values could contribute to the clinical diagnosis of type IA.

关 键 词：ROC曲线 半乳甘露聚糖 侵袭性曲霉病 

分 类 号：R519.8[医药卫生—内科学]