ROC曲线设置流式细胞术检测HLA-B27的临界值在强直性脊柱炎诊断和鉴别诊断中的应用  

Application of ROC Curve of Setting HLA-B27 Critical Value in the Diagnosis and Differential Diagnosis of Ankylosing Spondylitis

作　　者：张静[1] 董松武[2] 孙峰[1] ZHANG Jing;DONG Song-wu;SUN Feng(Department of Clinical Laboratory,Bozhou People’s Hospital,Anhui Bozhou 236800,China;Department of Cardiology,Bozhou People’s Hospital,Anhui Bozhou 236800,China)

机构地区：[1]亳州市人民医院检验科,安徽亳州236800 [2]亳州市人民医院心内科,安徽亳州236800

出　　处：《现代检验医学杂志》2020年第6期153-155,共3页Journal of Modern Laboratory Medicine

摘　　要：目的应用ROC曲线设定诊断强直性脊柱炎(ankylosing spondylitis,AS)的人类白细胞抗原(Human leukocyte attigen,HLA-B27)荧光临界值,评价其在AS诊断和鉴别诊断中的效能。方法利用流式细胞术对40例AS患者和169例与AS患者症状相近的其他关节病患者及健康对照进行HLA-B27荧光表达强度检测,比较各组荧光值差异,并进行ROC曲线分析,根据Youden指数计算出临界值,并与原设定临界值的诊断效能进行比较。结果AS组的荧光检测值、阳性率和对照组比较差异均具有统计学意义(F=40.45,P<0.05),以试剂盒给定的荧光临界值146为临界值,ROC曲线下面积(AUC)为0.92,诊断AS的敏感度、特异度、漏诊率、误诊率和准确度分别为90.00%,91.72%,10.00%,8.28%和91.39%,阳性预测值、阴性预测值和Youden指数分别为72.00%,97.48%和0.82。根据Youden指数确定最佳诊断临界值为151.50,其诊断敏感度、特异度、漏诊率、误诊率和准确度分别为90.00%,93.49%,10.00%,6.51%和92.82%,阳性预测值、阴性预测值和Youden指数分别为76.60%,97.53%和0.83。结论进口试剂盒设置的诊断临界值略低,实验室可在不影响诊断敏感度的前提下调整临界值,提高诊断AS的特异度。Objective To set the threshold value of HLA-B27 fluorescence detection level by using the ROC curve and evaluate its efficiency in the diagnosis and differential diagnosis of ankylosing spondylitis(AS).Methods Used flow cytometer from American BD company to detect the fluorescence intensity express levels of HLA-B27 from 40 patients with AS and 169 non-AS patients(as control group).According to the corresponding Youden index,obtained cut-off level by using the ROC curve analysis,comparing the diagnostic efficiency with the kit set.Results The difference of the fluorescence intensity express levels of HLA-B27 and the positive rate between the two groups were statistically significant(F=40.45,P<0.05).According to the cut-off level of BD company(146),the area under the ROC curve,the sensitivity,the specificity,the missed diagnosis rate,the misdiagnosis rate,Youden index and the accuracy were 0.92,90.00%,91.72%,10.00%,8.28%,0.82 and 91.39%,respectively.The positive predictive value,negative predictive value and Youden index were 72.00%,97.48%and 0.82,respectively.According to Youden indexof determine,the optimal diagnostic critical value,the corresponding diagnostic sensitivity,the specificity,the missed diagnosis rate,the misdiagnosis rate,the accuracy,the positive predictive value,the negative predictive value and Youden index were 151.50,90.00%,93.49%,10.00%,6.51%,92.82%,76.60%,97.53%and 0.83,respectively.Conclusion The diagnostic threshold of the imported kit reagent was slightly lower.The laboratory can raise the threshold without affecting the diagnostic sensitivity,the specificity of the diagnose of AS could be raised,and flow cytometer could be more useful for the clinical diagnosis and differential diagnosis.

关 键 词：强直性脊柱炎 类风湿关节炎 临界值 HLA-B27 流式细胞术 

分 类 号：R539.23[医药卫生—内科学] R392.11[医药卫生—临床医学]