ROC曲线评价(1,3)-β-D葡聚糖检测对ICU患者侵袭性真菌病的诊断价值

ROC curve in evaluation of (1,3)-β-D-glucan detection for diagnosis of invasive fungal disease in ICU

目的探讨重症监护病房(ICU)侵袭性真菌病(IFI)诊断中血清(1,3)-β-D葡聚糖(BDG)的阈值,通过受试者工作特征(ROC)曲线评价其临床意义。方法收集2011年1月-2014年3月ICU 52例IFI患者及200例非IFI患者的血清,将52例确诊和临床诊断患者设为IFI组,200例非IFI患者设为对照组,测定BDG含量,并绘制ROC曲线,分析BDG的最佳诊断值。结果 IFI组的BDG浓度均值为216.91pg/ml,对照组的BDG浓度均值为27.70pg/ml,IFI组显著高于对照组,且差异有统计学意义(P<0.05),BDG的ROC曲线下面积为0.903,最佳诊断阈值为50.0pg/ml,其对应的灵敏度、特异度、阳性预测值和阴性预测值分别为80.8%、94.5%、79.2%和95.0%。结论 BDG是诊断IFI的良好指标,在以50.0pg/ml为阈值时,特异度和敏感度均较为理想。

OBJECTIVE To investigate the diagnostic threshold of serum level of 1 ,3‐β‐D‐glucan （BDG） for ICU in‐vasive fungal infection （IFI ） ,and evaluate its clinical significance through the receiver operating characteristic （ROC） curve .METHODS Serum samples of 52 IFI patients and 200 non‐IFI patients in ICU from Jan .2011 to Mar .2014 were collected .The 52 confirmed and clinically diagnosed patients were established as the IFI group , and the 200 patients without IFI were set as the control group .The BDG level was detected and the ROC curve was drafted to analyze the optimal diagnostic value of BDG for diagnosis of IFI .RESULTS The average BDG con‐centration in the IFI group and the control group was 216 .91 pg/ml and 27 .70 pg/ml respectively ,indicating the BDG concentration value in the IFI group was significantly higher than the control group （P〈0 .05） .The ROC a‐nalysis showed that the area under the ROC curve of BDG was 0 .903 and the optimal diagnostic threshold was 50 .0 pg/ml .The corresponding sensitivity ,the specificity ,the positive predictive value and the negative predictive value were 80 .8% ,94 .5% ,79 .2% and 95 .0% ,respectively .CONCLUSION Serum BDG can serve as a good di‐agnostic indicator for IFI .At 50 .0 pg/ml as the threshold value ,the sensitivity and specificity is ideal .