应用ROC曲线评价MIP-1α在煤工尘肺早期诊断中的价值

Evaluation of MIP-1α Detection in Eearly Diagnosis of Coal Workers' Pneumoconiosis by Receiver Operating Characteristic Curve Analysis

[目的]构建受试者工作特征（ROC）曲线模型,应用ROC曲线探讨血清巨噬细胞炎症蛋白-1α（MIP-1α）在煤工尘肺病早期诊断中的价值。[方法]选择某煤业集团公司经职业健康检查的、肺部有小阴影但不够诊断为尘肺一期的180名接尘工人作为观察组,180名肺部完全正常的接尘工人作为接尘组,109名煤工尘肺一期患者作为病例组,采集空腹静脉血,使用酶联免疫吸附法测定3组研究对象血清中趋化因子MIP-1α的表达水平,采用ROC曲线对MIP-1α筛检煤工尘肺的作用进行评价。[结果]经协方差分析,控制年龄因素的影响后,病例组MIP-1α的表达水平均高于接尘组和观察组,差异均有统计学意义（P〈0.05）,观察组MIP-1α的表达水平高于接尘组,差异有统计学意义（P〈0.05）。对接尘工龄分层后进行分析,结果表明病例组在10-年、20-年和30-38年3个工龄段MIP-1α表达水平均高于观察组和接尘组,差异均有统计学意义（P〈0.05）,观察组在10-年、20-年和30-38年3个工龄段MIP-1α表达水平均高于接尘组,差异均有统计学意义（P〈0.05）;病例组、观察组和接尘组MIP-1α表达水平随着工龄的增加有增高趋势。构建ROC曲线,曲线下面积为0.874,最佳界值为940.85 ng/L,灵敏度为75.2%,特异度为90.0%,漏诊率为24.8%、误诊率为10%、约登指数为65.2%、阳性似然比为7.52、阴性似然比为0.28、符合率为0.87、Kappa值为0.63、阳性预测值为69.49%、阴性预测值为92.31%,收益是36人。[结论]经ROC曲线评价,MIP-1α作为筛检指标具有较高的真实性和可靠性,在煤工尘肺早期诊断中具有较高的参考价值。

[ Objective ] To explore the value of maerophage inflammatory protein-Is （MIP-la） in early diagnosis of coal workers＇ pneumoeoniosis by establishing a receiver operating characteristic （ROC） curve model. [ Methods ] Serum levels of MIP- Ia were determined by enzyme-linked immunosorbent assay （ELISA） in 180 suspected silicosis patients with small lung opacity （observation group）, 180 silica dust exposed workers without pneumocomosls （dust exposed group）, and 109 stage I pneumeconiosis patients （case group）. Evaluation of serum MIP-1α detection in screening coal workers＇ pneumoconiosis was using ROC curve analysis. [ Results ] By analysis of covariance, controlling for age, the serum levels of MIP-Ia in the case group were significantly higher than those in the exposed group and the observation group （P〈0.05）; and the levels of MIP-la in the observation group were significantly higher than those in the exposed group （P〈0.05）. When stratified by seniority, the levels of MIP-la in the case group were significantly higher than those in the observation group or in the exposed group for dust exposure duration of 10- years, 20- years. or 30 to 38 years （P〈O.05）; the levels of MIP-la in the observation group were significantly higher than those in the exposed group for the above three durations （P〈 0.05）. The MIP-la level increased with seniority for the three groups. The ROC analysis indicated the area under the ROC curve was 0.874, the optimal criterion value was 940.85ng/L, the sensitivity was 75.2%, the specificity was 90.0%, the missed diagnosis rate was 24.8%, the misdiagnosis rate was 10%, the Youden index was 65.2%, the positive likelihood ratio was 7.52, the negative likelihood ratio was 0.28, the agreement was 0.87, the Kappa value was 0.63, the positive predictive value was 69.49%, the negative predictive was 92.31%, and the yield was 36 people. [ ConGlusion ] MIP-la as a screening indicator has the advantages in high validity and reliability, and therefore can be used for coal workers＇ pneumoconiosis early diagnosis.