ROC曲线评价相关指标对重症小儿麻疹合并肺炎的诊断价值  

Evaluating the diagnostic value of some related index for children with severe measles combined pneumonia by ROC curve

作　　者：安淑华[1] 刘小娟[1] 李金英[1] 李权恒[1] 刘兰平[1] 高文杰[1] 田利远[1] 王亚坤[1] 李清涛[1] 杨帆[1] 

机构地区：[1]河北省儿童医院呼吸一科,河北石家庄050031

出　　处：《中华全科医学》2016年第3期359-361,411,共4页Chinese Journal of General Practice

基　　金：河北省科技计划项目(13277725D)

摘　　要：目的本文通过探讨麻疹合并肺炎患儿的临床特点,分析提示重症患儿的相关指标,运用受试者工作特征曲线（receiver operating characteristic curve,ROC）评价其诊断重症麻疹合并肺炎的价值,从而提高认识,指导治疗。方法回顾性分析河北省儿童医院呼吸一科住院治疗的62例麻疹合并肺炎患儿的临床资料,根据病情将患儿分为重症组（n=15）与对照组（n=47）。入院24 h内空腹抽取静脉血采用仪器法检测外周血WBC、NE%、PLT,免疫比浊法检测CRP及Ig M、Ig A、Ig G,酶法检测LDH,溴甲酚绿法检测白蛋白。运用单因素统计分析方法,比较2组患儿的临床特点及实验室指标,对差异有统计学意义的指标绘制ROC曲线。结果 2组患儿麻疹疫苗接种史、WBC、NE%、PLT、Ig M、Ig A、Ig G、白蛋白差异无统计学意义（P〉0.05）。重症组入院前病程[10.0（5.0,15.0）d]长于对照组[6.0（3.0,10.0）d],热程[11.0（8.0,16.0）d]长于对照组[7.0（3.0,9.0）d]（P〈0.05）。重症组CRP[17.0（4.0,50.0）mg/L]高于对照组[6.0（1.0,13.0）mg/L],其LDH[433.0（373.0,601.0）U/L]高于对照组[352.0（277.0,427.0）U/L]（均P〈0.05）。经ROC曲线评价,入院前病程、热程、CRP、LDH的ROC曲线下面积（the areas under the ROC curve,AUC）分别为0.689、0.784、0.723、0.731,临界值分别为9 d、7.5 d、25.5 mg/L、366.0 U/L,其诊断重症麻疹合并肺炎患儿的敏感度分别为60.0%、93.3%、73.3%、86.7%,特异度分别为74.5%、57.4%、68.1%、59.6%,95%CI分别为0.547-0.830、0.657-0.911、0.566-0.881、0.587-0.876。结论入院前病程、热程、CRP、LDH是重症麻疹合并肺炎的相关指标。入院前病程、热程长及CRP、LDH高的患儿易表现为重症麻疹合并肺炎。入院前病程对重症麻疹合并肺炎具有较低诊断价值,而热程、CRP、LDH具有中等诊断价值。Objective To explore the clinical features of children with measles combined pneumonia,and evaluate the severity-related indicators by the ROC curve. Methods The clinical data of 62 children with measles combined pneumonia in our hospital were reviewed. The patients were divided into severe group（ n = 15） and the control group（ n = 47） according to the condition. The fasting venous blood within 24 h after the admission was prepared for the test of WBC,NE%,PLT,CRP,Ig M,Ig A,Ig G were tested with immunoturbidimetric assay,LDH with enzymatic method,and albumin with bromocresol green method. The clinical characteristics and laboratory indexes of both groups were compared with single factor analysis,and the ROC curve for the indicators which had statistical difference. Results The history of measles vaccination,WBC,NE%,PLT,Ig M,Ig A,Ig G between the two groups had no statistical differences. The course prior to the admission in the severe pneumonia group was 10. 0（ 5. 0,15. 0） d which was longer than that in the control group[6. 0（ 3. 0,10. 0） d]; the duration of fever of children was 11. 0（ 8. 0,16. 0） d which was longer than that in the control group[7. 0（ 3. 0,9. 0） d]（ P〈0. 05）; the CRP was 17. 0（ 4. 0,50. 0） mg/L which was higher than that in the control group[6. 0（ 1. 0,13. 0） mg/L],LDH was 433. 0（ 373. 0,601. 0） U/L which was higher than that in the control group[352. 0（ 277. 0,427. 0） U/L],P〈0. 05. The AUC（ area under the ROC curve） of the course prior to admission,duration of fever,CRP,LDH were 0. 689,0. 784,0. 723 and 0. 731,respectively; the critical value was 9,7. 5 d,25. 5 mg / L and 366. 0U / L,respectively; the sensitivity was 60. 0%,93. 3%,73. 3% and 86. 7%,respectively; and the specific degrees was74. 5%,57. 4%,68. 1% and 59. 6%,respectively; 95% CI was 0. 547- 0. 830,0. 657- 0. 911,0. 566- 0. 881,0. 587-0. 876,respectively. Conclusions The course prior to admission,duration of fever,CRP,LDH are the related indicators.The patients whose course prior

关 键 词：重症肺炎 麻疹 ROC曲线 儿童 

分 类 号：R511.1[医药卫生—内科学] R563.1[医药卫生—临床医学]