应用ROC曲线评价肝功能指标在妊娠肝内胆汁淤积症诊断中的价值

Application of ROC curves in evaluating values of liver function indexes for diagnosing intrahepatic cholestasis of pregnancy

目的应用受试者工作特征曲线(ROC曲线)评价肝功能指标———总胆红素(TBI)、结合胆红素(DBI)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷胺酰转移酶(γ-GGT)和总胆汁酸(TBA)在妊娠肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)诊断中的价值。方法通过检测ICP组和对照组ALT、AST、γ-GGT、TBIL、DBIL、TBA等指标,应用ROC曲线分析方法 ,评价以上几项指标诊断ICP的敏感度及特异性。结果 TBIL、DBIL、ALT、AST、γ-GGT及TBA诊断ICP的ROC曲线下面积(AUC)分别为0.665、0.835、0.759、0.822、0.736、0.848,最佳分界值分别为13.65μmol/L、2.75μmol/L、54.00 U/L、44.50 U/L、20.50 U/L、11.10μmol/L,敏感度分别为36.6%、72.6%、60.6%、63.4%、66.6%、70.6%,特异性分别为92.3%、86.6%、93.4%、93.7%、70.3%、88.0%。两组结局比较显示ICP患者的早产率、胎儿宫内窘迫发生率、羊水胎粪污染率、胎儿死亡率均大大增高。结论基于ROC曲线分析,建议TBA>11.1μmol/L,同时ALT>54 U/L、AST>44.5 U/L的孕妇临床可诊断为ICP。

Objective To apply the receiver operating characteristic（ROC）curves to evaluate the values of TBil,DBil,ALT,AST,γ-GGT and TBA for diagnosing intrahepatic cholestasis of pregnancy（ICP）.Methods By testing TBil,DBil,ALT,AST,γ-GGT and TBA in the ICP group and the normal control group,using the ROC curves to evaluate the sensitivity and specificity of above indexes in the diagnosis of ICP.Results The area under curve（AUC）of TBil,DBil,ALT,AST,γ-GGT and TBA for diagnosing ICP were 0.665,0.835,0.759,0.822,0.736 and 0.848 respectively,the optimal cut-off values were 13.65 μmol/L,2.75 μmol/L,54.00 U/L,44.50 U/L,20.50 U/L and 11.10 μmol/L respectively,the sensitivities were 36.6%,72.6%,60.6%,63.4%,66.6% and 70.6% respectively,and the specificities were 92.3%,86.6%,93.4%,93.7%,70.3% and 88.0% respectively.The outcomes comparison of the two groups showed that the premature birth rate,incidence of fetal intrauterine distress,rate of meconium-stained amniotic fluid and fetal mortality in the ICP group were greatly increased.Conclusion Based on the analysis of ROC curves,pregnant women with TBA11.1 μmol/l,ALT54 U/L and AST44.5 U/L should be clinically diagnosed as ICP.