ROC曲线评价血清相关指标在血液病患者血流感染中的诊断价值  

Diagnostic Value of ROC Curve Evaluating Serum Related Indexes for Bloodstream Infection in Patients with Hematopathy

作　　者：张伟 陈众 王微微 陆文英 商安全 胡丽庆[5] ZHANG Wei;CHEN Zhong;WANG Wei-Wei;LU Wen-Ying;SHANG An-Quan;HU Li-Qing(Department of Laboratorial Medicine,The Fifth People’s Hospital of Jiaozuo City,Jiaozuo 454000,Henan Province,China;Department of Laboratorial Medicine,Luoyang Hospital of Traditional Chinese Medicine,Jiaozuo 454000,Henan Province,China;Department of Pathology,Yancheng Sixth People’s Hospital,Yancheng 224001,Jiangsu Province,China;Department of Laboratorial Medicine,Tongji Hospital of Tongji University,Shanghai 200065,China;Department of Laboratorial Medicine,The First Hospital of Ningbo,Ningbo 315010,Zhejiang Province,China)

机构地区：[1]焦作市第五人民医院检验科,河南焦作454000 [2]洛阳市中医院检验科,河南洛阳471000 [3]盐城市第六人民医院病理科,江苏盐城224001 [4]同济大学附属同济医院检验科,上海200065 [5]宁波市第一医院检验科,浙江宁波315010

出　　处：《中国实验血液学杂志》2020年第5期1746-1749,共4页Journal of Experimental Hematology

基　　金：国家自然科学基金(81802084,81873975);上海市医疗卫生系统优秀学科带头人培养计划(2018BR31);上海市自然科学基金(19ZR1448800);上海市医学引导类科技支撑计划(19411964800);上海市同济医院临床培育项目[ITJ(ZD)1803,ITJ(ZD)1905];2017年焦作市医学科研项目(2017KY057);盐城市医学科技发展计划项目(YK2019112、YK2017120、YK2017121);盐城市医学重点人才项目;盐城市医学创新团队项目;江苏省卫生健康委员会医学研究项目(Z2019039)。

摘　　要：目的:评价血清降钙素原(PCT)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)在血液病患者血流感染(BSI)中的诊断价值。方法:选取分析2016年7月-2018年6月医院诊断为血流感染的血液病患者60例,设为血流感染组;选择同期血培养阴性患者65例,设为非血流感染组。绘制ROC曲线对各指标诊断价值进行评价。结果:血流感染组PCT、CRP、SAA水平高于非血流感染组(P<0.05)。ROC曲线显示,PCT、CRP、SAA及联合试验检测的AUC值分别为0.868、0.746、0.678和0.900。联合试验检测与PCT检测的AUC比较,差异无统计学意义(P>0.05),联合试验检测及PCT检测的AUC分别大于CRP与SAA检测的AUC,差异有统计学意义(P<0.05)。CRP与SAA检测的AUC差异无统计学意义(P>0.05)。PCT检测最佳临界值为0.49 ng/ml,敏感度与特异度分别为75.0%和83.1%。CRP检测最佳临界值为15.76 mg/L,敏感度与特异度分别为60.0%和80.0%。SAA检测最佳临界值为35.66 mg/L,敏感度与特异度分别为81.7%和53.8%。结论:对于血液病患者PCT、CRP、SAA检测对血流感染有着较好的诊断价值,PCT诊断价值优于CRP与SAA,联合试验检测与PCT单项检测的诊断价值无显著差异。Objective:To evaluate the diagnostic value of serum PCT,CRP and SAA for bloodstream infection(BSI)in patients with hematopathy.Methods:Sixty hematopathy patients with bloodstream infection from July 2016 to June 2018 were selected and enroued in bloodstream infection group.Sixty-five patients with negative blood culture during the same period were selected and enrolled in non-bloodstream infection group.The ROC curves were drawn and used to eualuate the diagnostic value of above montioned indexes.Results:The levels of PCT,CRP and SAA in the bloodstream infection group were higher than those in the non-bloodstream infection group(P<0.05).ROC curve showed that AUC values of PCT,CRP,SAA and the combined test detection were 0.868,0.746,0.678 and 0.900,respectively,there was no significant difference in AUC between combined test and PCT test(P>0.05).AUC of combined test and PCT test were higher than those of CRP and SAA test,and the difference was statistically significant(P<0.05),but there was no significant difference in AUC between CRP and SAA(P>0.05).The optimal PCT detection threshold was 0.49 ng/ml,the sensitivity and specificity were 75.0%and 83.1%,respectively.The optimal critical value for CRP detection was 15.76 mg/L,the sensitivity and specificity were 60.0%and 80.0%respectively.The optimal SAA detection threshold was 35.66 mg/L,the sensitivity and specificity were 81.7%and 53.8%,respectively.Conclusion:PCT,CRP and SAA detection have good diagnostic value for blood stream infection in patients with hematopathy.The diagnostic value of PCT is better than CRP and SAA,and there is no significant difference in diagnostic value between combined test and PCT test.

关 键 词：血流感染 降钙素原 C反应蛋白 血清淀粉样蛋白A 诊断价值 

分 类 号：R733[医药卫生—肿瘤] R181[医药卫生—临床医学]