艾滋病合并马尔尼菲青霉菌病临床诊断评分体系的建立及评价

Establishment and preliminary evaluation of clinical diagnostic scoring system for AIDS-associated Penicilliosis Marneffei

目的建立艾滋病（AIDS）合并马尔尼菲青霉菌病（PSM）的临床诊断评分体系,并对其运用价值进行初步评价。方法采用回顾性研究的方法,对柳州市人民医院2010年4月至2015年5月309例AIDS住院患者的临床和实验室资料,通过SPSS 19.0软件随机化分组（建模组240例和验模组69例）。选择两组间有统计学差异的变量进行Logistic回归分析,筛选出对PSM诊断有影响的独立变量。根据各变量的β回归系数设立相应分值,并建立PSM的临床诊断评分体系（PSMCDS）,用受试者工作特征曲线（ROC曲线）评价PSMCDS的预测价值,最后用验模组的临床资料对PSMCDS进行验证。结果共有5个因素被筛选入模型中,分别为外周或腹腔淋巴结肿大、肝肿大、脾肿大、AST〉1×ULN且AST〉ALT、CD4＋T淋巴细胞（简称CD4细胞）计数的自然对数,建立了由这5个变量组成的PSMCDS,分别为外周或腹腔淋巴结肿大（10分）、肝脏肿大（10分）、脾脏肿大（10分）、AST〉1×ULN且AST〉ALT（达标20分）、CD4细胞计数〉25个/!L≤50个/!L（5分）及≤25/!L（10分）。取分值≥35.0时,用于诊断PSM的曲线下面积（AUC）为0.871[95%可信区间（CI）：0.824-0.918（P〈0.05）],灵敏度、特异性、阳性预测值、阴性预测值分别为73.9%、87.4%、90.6%和66.4%。验模组验证结果：AUC为0.838（95%CI：0.746-0.930）（P〈0.05）。结论 5个变量建立的PSM临床诊断评分体系简单易行,在PSM流行地区,用于评估CD4细胞计数〈200个/!L的AIDS病人是否合并PSM有较好的临床诊断价值。

Objective To develop a clinical diagnostic scoring system for diagnosis of acquired immunodeficiency syndrome（AIDS）associated penicilliosis marneffei（PSM）and to testify the application value.Methods A retrospective study was performed on hospitalized PSM patients associated with AIDS in the people′s hospital of Liuzhou from April 2010 to May 2015.By SPSS,309 patients were randomly divided into 2groups with one for modelling（n=240）and another for validation（n=69）,with their symptoms and laboratory parameters recorded.There were153 AIDS patients with PSM and 87 without PSM in the modeling group.Binary logistic regression was used to analyze the variables with statistical difference to develop diagnostic scoring criteria according to theirβcoefficients.The receiver operating characteristic（ROC）curve was used to calculate predictive value of the criteria.Performance of the model was tested by the validation group of 69 new cases.Results Five variables were selected in the clinical diagnostic scores including peripheral or abdominal nodes（10.0points）,hepatomegaly（10.0points）,splenomegaly（10.0points）,AST〉1× ULN and AST 〉 ALT（20.0points）,25/!L〈CD4＋T lymphocyte count≤50/!L（5.0points）and CD4＋T lymphocyte count≤25μL（10.0points）.With a cut-off value of 35.0points,the area under the curve（AUC）in PSM diagnosis was 0.871（95%CI：0.824-0.918）（P 〈 0.05）, and the sensitivity,specificity,positive predictive value and negative value were 73.9%,87.4%,90.6% and 66.4% respectively.With application of the scoring criteria,the area under the curve（AUC）in PSM diagnosis was 0.838（95%CI：0.746-0.930）（P〈0.05）.Conclusion For the patients associated with AIDS whose CD4＋T lymphocyte counts was less than 200μL,the scoring criteria can provide an easy and practical way to facilitate PSM diagnosis.