ROC曲线评价AFP在急性肝衰竭预后中的应用

Assess the value of the AFP level for the prognosis of acute liver failure disease with ROC curve

目的研究AFP定量对急性肝衰竭预后的判断价值。方法 2009年1月至2012年1月连续收集在解放军第302医院住院的71例急性肝衰竭患者。所有患者均行AFP定量检测,并随访3个月。根据实际预后将患者分为生存组(n=21)及死亡组(n=50)。采用独立变量的非参数检验比较生存组和死亡组AFP水平;利用ROC曲线分析AFP水平在评价急性肝衰竭患者预后中的作用,并结合临界值进行四格表分析。结果生存组患者AFP水平(186μg/L)明显高于死亡组(36.5μg/L,P=0.004)。通过ROC分析显示,以121μg/L作为急性肝衰竭预后好转判断的临界值时,其曲线下面积(AUC)达到0.719,灵敏度和特异度分别为0.714和0.700,对预后判断的准确率为0.714,阳性预测值为50%,阴性预测值为85.4%。结论 AFP水平121μg/L是急性肝衰竭患者预后判断的临界值,其灵敏度和特异度、准确率较好,阴性预测值较高。

Objective To assess the value of the AFP（the alpha fetopmtein）level for the prognosis of acute liver failure disease. Methods 71 patients with acute liver failure were investigated from 302 Military Hospital during Jan 2009 to Jan 2012. AFP level in serum was detected. An the patients were followed for 3 months. The patients were divided into survivor group （ n -- 21 ） and non-survivor group （ n = 50 ） according to the outcome. AFP level was compared between survivor group and non-survivor using independent variable non-parameter test and the role of AFP level in the prognosis of the ALF patients were analyzed by the receiver operating characteristic curve （ROC curve）and the fourfold table. Results AFP level in survivor group（ 186 μg/L）was much higher than non- survivor（36. 5 μg/L,P =0. 004）. The cutoff value of the AFP level evaluated by ROC curve was 121 μg/L. The area under curve（AUC） was 0. 719 with the sensibility 0. 714 and specificity 0. 700, and the accuracy for prognosis was 0. 714 with the negative predictive value 85.4% ,the positive predictive value 50%. Conclusions The cutoff value of the AFP level for the prognosis of acute liver failure disease was 121μg/L, with a better sensibility ,specificity, diagnosis accuracy, and a higher negative predictive value.