应用受试者工作特征曲线评价α-L-岩藻糖苷酶对良恶性腹水的诊断价值

Evaluation of the Value of α-L-fucosidase Levels with Receiver Operating Characteristic Curve in the Diagnosis of Benign and Malignant Ascites

目的应用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)探讨α-L-岩藻糖苷酶(AFU)对恶性腹水和非结核良性腹水的诊断价值。方法 2004年7月—2008年1月对213例诊断明确的良、恶性腹水(其中良性腹水117例、恶性腹水96例)AFU活性进行检测。采用ROC曲线评价AFU的诊断灵敏度、特异度、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比及Youden指数,评价其诊断效率。结果恶性腹水组AFU水平(164.96±87.72)μmol/(L.h),良性腹水组(104.02±62.07)μmol/(L.h),两者比较差异有统计学意义(P<0.01)。AFU诊断恶性腹水的ROC曲线下面积为0.754±0.034,最佳分界值101.95μmol/(L.h)。以AFU≥101.95μmol/(L.h)来预测恶性腹水,其诊断的灵敏度为82.3%,特异度为63.2%,准确性为72.8%、阳性预测值为65.3%、阴性预测值为83.1%、阳性似然比为2.23、阴性似然比为0.28及Youden指数为0.455。结论腹水AFU活性检测有助于恶性腹水和非结核良性腹水的鉴别诊断,是一个比较理想的实用指标,适合于基层医院的临床应用。

Objective To assess the value of α-L-fucosidase（AFU） levels with receiver operating characteristic curve（ROC curve） in the diagnosis of malignant and non-tuberculous benign ascites.Methods Ascitic AFU activity was measured in 213 patients（117 with benign ascites and 96 with malignant ascites） diagnosed with benign or malignant ascites.The diagnostic sensitivity（SEN）,specificity（SPE）,accuracy,positive predictive value（PV＋）,negative predictive value（PV-）,positive likelihood ratio（LR＋）,negative likelihood ratio（LR-） and Youden index（YI） of AFU were assessed with receiver operating characteristic curve,and the diagnostic effectiveness of AFU was evaluated.Results The average level of AFU in the malignant group [（164.96±87.72） μmol/（L·h）] was significantly higher than that in the benign group [（104.02±62.07） μmol/（L·h）]（P0.01）.The area under the curve（AUC） of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis,and the optimal cut-off value was 101.95 μmol/（L·h）.When an AFU level equal to or higher than 101.95 μmol/（L·h） was used to predict malignant ascites,the diagnostic sensitivity was 82.3%,specificity was 63.2%,accuracy was 72.8%,PV＋ was 65.3%,PV-was 83.1%,LR＋ was 2.23,LR-was 0.28 and YI was 0.455.Conclusion Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites,which is a relatively ideal index to fit for clinical application of local hospitals.