Logistic回归和ROC工作曲线评价联合检测血清CA153,TPS,CYFRA21-1在乳腺癌诊断中的临床价值  

Clinical Value of Logistic Regression and ROC Work Curve Evaluating Serum CA153,TPS and Cyfra21-1 for Diagnosis of Breast Cancer

作　　者：高华[1] 李玉柱[2] 韩龙才[3] 张华[2] 张海军[2] 林秋全[2] 王磊[4] GAO Hua;LI Yu-zhu;HAN Long-cai;ZHANG Hua;ZHANG Hai-jun;LIN Qiu-quan;WANG Lei(Department of Clinical Laboratory;Department of Radiology;Department of Surgery;3. Department of Pathology, Tangshan People ＇ s Hospital, Hebei Tangshan 063000,Chin)

机构地区：[1]唐山市人民医院核医学检验科,河北唐山063000 [2]唐山市人民医院放射科,河北唐山063000 [3]唐山市人民医院外科,河北唐山063000 [4]唐山市人民医院病理科,河北唐山063000

出　　处：《现代检验医学杂志》2018年第3期60-64,共5页Journal of Modern Laboratory Medicine

基　　金：2017年度河北省医学科学研究重点课题(项目编号:20171292)

摘　　要：目的通过Logistic回归和ROC工作曲线综合分析糖链抗原153(CA153)、组织多肽特异抗原(TPS)、细胞角质蛋白19片段(cytokeratin 19fragment antigen 21-1,CYFRA21-1)联合检测在乳腺癌诊断中的临床价值。方法采用罗氏全自动电化学发光仪检测50例乳腺癌患者(乳腺癌组)、30例健康者(对照组)血清CA153,TPS和CYFRA21-1水平,分析比较乳腺癌组与对照组三项指标水平的差异,两组三项指标单项及联合检测阳性率比较;两组血清CA153,TPS,CYFRA21-1单项与联合检测对乳腺癌诊断试验的评价指标比较;通过Logistic回归建立回归模型,用ROC工作曲线分析CA153,TPS和CYFRA21-1对乳腺癌的诊断价值。结果(1)乳腺癌组患者血清CA153,TPS和CYFRA21-1水平较对照组明显升高,差异具有统计学意义(t=3.30,P=0.001;t=2.78,P=0.007;t=4.31,P=0.000 05);(2)单项检测的阳性率从高到低依为:CYFRA21-1(60.0%)>TPS(54.0%)>CA153(50.0%),CA153+TPS+CYFRA21-1的阳性率为70.0%,比单项检测显著升高;(3)单项检测中CYFRA21-1的敏感度较高,CA153的特异度较高,单项检测与三项联合检测比较敏感度由50.0%升高到70.0%,符合率由67.5%升高到77.5%,阴性预测值由53.7%升高到64.3%,特异度、阳性预测值略有下降;(4)通过Logistic回归得乳腺癌的概率预测回归模型Y=1/[1+EXP(0.099 X1+0.038 X2+0.578 X3-9.694)],三项联合检测的ROC曲线下面积明显大于CA153,TPS,CYFRA21-1单独检测的ROC曲线下面积。结论联合检测血清CA153,TPS,CYFRA21-1在乳腺癌早期诊断中具有重要的临床价值。Objective To analyse comprehensively Clinical Value of Logistic regression and ROC curve of detection combined with serum carbohydrate antigen （CA） 153, tissue polypeptide specific antigen （TPS） and cell keratin segments of 19 （CY- FRA21-1） for diagnosis of breast cancer. Methods Used Roche Automatic Electrochemical Luminescence Instrument to de- tect serum CA153,TPS and CYFRA21-1 level of 50 patients with breast cancer （breast cancer group） and 30 cases of healthy subjects （control group）. Analysed and compared serum CA153, TPS and CYFRA21-1 level difference of breast cancer group and control group, and single and joint detection of serum CA153, TPS and CYFRA21-1. The diagnosis per- formance of breast cancer （sensitivity, specificity, coincidence rate, positive predictive value and negative predictive value） was compared between the two groups of serum CA153, TPS and CYFRA21-1. The regression model was established by Lo- gistic regression,and ROC curve analyzes CA153,TPS and CYFRA21-1 value to the diagnosis of breast cancer. Results ① In the breast cancer group the serum CA153, TPS and CYFRA21-1 levels werehigher than those in the control group, and the difference was statistically significant （P〈0.05）. ②The positive rate of single test was from high to low： CYFRA21 1 （60.0%） 〉TPS （54.0%） 〉 CA153 （50.0%）, CA153 ＋ TPS＋CYFRA21-1 with a positive rate of 70.00%00, significantly higher than that of single-item detection. ③CYFRA21-1 in single detection sensitivity was higher, CA153 specific degrees higher, single detection compared with three joint detection sensitivity increased from 50.0 % to 70.0 %, the coincidence rate increased from 67.5 % to 77.5 %, negative predictive value increased from 53.7 % to 64.3 %, specific degree, positive predictive value fell slightly. ④The regression model Y= 1/[1 ＋ EXP（0. 099X1 ＋ 0. 038X2 ＋0. 578X3 --9. 694）], the area under the ROC curve of the three joint tests was significantly larger than that of the ROC curv

关 键 词：乳腺癌 血清糖类抗原153 组织多肽特异性抗原 细胞角质蛋白19片段 

分 类 号：R737.9[医药卫生—肿瘤] R730.43[医药卫生—临床医学]