对毒性弥漫性甲状腺肿病运用ROC曲线评价促甲状腺激素受体抗体的诊断准确率研究

Research on the evaluation of diagnostic accuracy of thyrotropin receptor antibody by ROC curve in patients with toxic diffuse goiter

目的研究对毒性弥漫性甲状腺肿(Graves)病运用ROC曲线评价促甲状腺激素受体抗体的诊断准确率。方法回顾性选取2018年6月至2019年6月阳江市阳东区人民医院甲状腺功能紊乱患者776例,依据Graves病诊断标准分为Graves病组(n=412)和非Graves病组(n=364)。另回顾性选取同期我院健康体检人员300例作为健康对照组,统计分析三组人员的血清促甲状腺激素受体抗体(TRAb)水平,分析ROC曲线评价TRAb诊断Graves病的价值。结果Graves病组患者的血清TRAb水平显著高于非Graves病组、健康对照组(P<0.05)。AUC=0.973(95%CI 0.945~1.000),诊断临界值为50.3 IU/ml,敏感度、特异度分别为96.0%(95%CI 80.0%~100.0%)、91.1%(95%CI 83.6%~98.6%),准确率为92.6%,阳性预测值、阴性预测值分别为82.8%、98.1%,Youden值为87.1%。95%健康人群TRAb单侧参考范围为0~45.4 IU/ml。结论对Graves病运用ROC曲线评价促甲状腺激素受体抗体的诊断准确率高。

Objective To research the diagnostic accuracy of thyrotropin receptor antibody(TRAb)by ROC curve in patients with toxic diffuse goiter(Graves disease).Methods A total of 776 patients with thyroid dysfunction admitted to our hospital from June 2018 to June 2019 were selected retrospectively,and they were divided into the Graves disease group(n=412)and the non-Graves disease group(n=364)according to the diagnostic criteria of Graves disease.In addition,300 health examination personnel admitted to our hospital in the same period were selected retrospectively as the healthy control group,and the serum TRAb levels of the three groups were statistically analyzed,and the ROC curve was analyzed to evaluate the value of TRAb in diagnosing Graves disease.Results Serum TRAb level in the Graves disease group was significantly higher than that in the non-Graves disease group and the healthy control group(P<0.05).The AUC value was 0.973(95%CI 0.945-1.000),the diagnostic cut-off value was 50.3 IU/ml,and the sensitivity and specificity were 96.0%(95%CI 80.0%-100.0%)and 91.1%(95%CI 83.6%-98.6%),respectively,and the accuracy rate was 92.6%.The positive predictive value and negative predictive value were 82.8%and 98.1%respectively,and Youden value was 87.1%.The unilateral reference range of TRAb in 95%healthy people was 0-45.4 IU/ml.Conclusion The diagnostic accuracy of ROC curve in evaluating TRAb is high for Graves disease.