ROC曲线在血液透析患者心室重构诊断中的应用  

ROC curve and diagnosis of ventricular remodeling in hemodialysis patients

作　　者：钱慕周[1] 陈澄[1] 贾蔚[1] 葛晓燕[2] 刘唯薇 康爱萍[3] 张翼翔[4] 

机构地区：[1]南通市第四人民医院血液净化中心,226005 [2]南通市第四人民医院心内科,226005 [3]南通市第四人民医院B超室,226005 [4]上海第二军医大学长征医院

出　　处：《国际移植与血液净化杂志》2016年第6期24-26,共3页International Journal of Transplantation and Hemopurification

基　　金：南通市科技局社会事业科技创新与示范指令性课题（HS2014037）

摘　　要：目的 运用ROC曲线探讨血清超敏C反应蛋白（hsCRP）、肿瘤坏死因子-α（TNF-α）诊断维持性血液透析（MHD）患者心室重构和微炎症状态的准确性.方法 选取2014年1月至2015年12月在我科规律透析、血液龄≥3个月、病情稳定的MHD患者100例,使用多普勒超声心动图测定左心室舒张末期内径（LVDd）、舒张末期室间隔厚度（LVST）、舒张末期左心室后壁厚度（LVPWT）等,计算左室心肌重量指数（LVMI）,根据有/无发生心室重构分为观察（A,60例）组与对照（B,40例）组.检测两组患者血清hsCRP、TNF-α、甲状旁腺素（PTH）、血肌酐（Ccr）等.以hsCRP、TNF-α水平对心室重构的诊断绘制ROC曲线.结果 A组患者血清hsCRP、TNF-α、PTH、Ccr水平显著高于B组（均P〈0.05）.多元线性回归分析示,A组患者hsCRP、TNF-α、PTH、Ccr与LVMI值呈正相关（F=73.62,P〈 0.01）,且hsCRP、TNF-α对LVMI值影响最大.ROC曲线示,hsCRP、TNF-α与MHD患者LVMI值关系密切,其升高程度与心室重构的严重程度呈正比.结论 血清hsCRP、TNF-α水平可反映LVMI值变化,动态观察血清hsCRP、TNF-α水平对预先判断MHD患者心室重构具有重要的临床意义.Objective To investigate the effect of Creative protein and tumor necrosis factor on the diagnosis of ventricular remodeling and slight inflammation in MHD patients by ROC curve.Methods 100 MHD patients with regular dialysis and stable condition collected from 01/2014 to 12/2015 were randomly divided into two groups,the observation group with ventricular remodeling （A,n =50） and the control group without it （B,n =50）,according to left ventricular end-diastolic dimension （LVDd）,left ventricular septum thickness （LVST）,left ventricular posterior wall thickness （LVPWT）,and the calculated left ventricular mass index （LVMI）.The Creative protein （hsCRP） and tumor necrosis factor-α（TNF-α）,parathormone（PTH）and serum creatinine （Ccr） were measured.And ROC curve was made according to the serum hsCRP and TNF-α.Results Serum hsCRP,TNT-α,PTH and Ccr in A group was higher than that in B group （P 〈 0.05）.Multiple linear regression results showed that the serum hsCRP,TNF-α,PTH and Ccr in A group was positively associated with LVMI（F=73.62,P〈0.01） and serum hsCRP and TNT-α had strong influence.The ROC curve results also showed that the serum serum hsCRP and TNF-α was positively associated with LVMI in MHD patients,and the degree of the increased concentration was strong positively associated with the degree of ventricular remodeling.Conclusion Serum hsCRP and TNF-α was positively associated with LVMI and serum hsCRP and TNF-α play an important role in the ventricular remodeling in MHD patients.

关 键 词：ROC曲线 维持性血液透析 心室重构 微炎症状态 超敏C反应蛋白 肿瘤坏死因子 

分 类 号：R54[医药卫生—心血管疾病] R692[医药卫生—内科学] R45[医药卫生—临床医学]