应用ROC曲线选择终末期肾病患者开始透析时机

Application of receiver operating charasteristic （ROC） curve in determing the occasion of initiation of dialysis in end stage senal disease

目的应用ROC工作曲线选择终末期肾病（ESRD）患者开始血液透析时残余肾功能水平的界值，探讨其在ESRD患者的应用价值。方法回顾分析我院血液透析中心2001年6月至2006年6月开始第1次血液透析的146例ESRD患者的临床资料，同期获得血清C反应蛋白（SCRP）和肾功能检查等数据。采用ROC工作曲线选择最佳开始透析时机。结果①SCRP浓度与肾功能水平呈负相关；②选择肾小球滤过率（GFR）8．5ml／min时，诊断的灵敏度为88．9％，特异性为89．5％，准确性为88．3％。结论慢性肾衰竭患者SCRP水平增高；当肾功能下降到一定水平后会引起SCRP明显升高，应用ROC曲线选择GFR8．5ml／min具有较高的灵敏度、特异性；此法对制定科学的开始血液透析时肾功能标准具有重要的临床意义。

Objective To study the out-off value of glomerular filtration rate （GFR） of ESRD patients at the initiation of hemodialysis by ROC cure. Method serum c-reactive protein（SCRP）, creatinine, blood urea nitrogen and other einical and laboratory data of all 146 ESRD in-patients who initiated their first hemodialysis treatment at blood purification center in our hospital during June of 2001 to June of 2006 were invesfigateel retrospectively. The best cut-off level of GFR was based on the receiver operating characteristics （ROC） curve. Results （1）In general, there was inverse linear correlation between SCRP and GFR（r = - 0. 648, P = 0. 000）. （2）The cut-off value of GFR was 8. 5 ml/min. The sensitivity, specificity, accuracy were 88. 9%, 89. 5%, 88.3%, respectively. Conclusions The SCRP level increases in patients with chronic renal failure, and increases significantly when residual renal function fal.l.s bel.ow certain level.. 8. 5 ml./min as the cut-off val.ue pessesses higher sensitivity and specificity. It has important clinical significance for establishing a scientific criterion for nesidual nenalfunchin during initiating hemodialysis.