多项临床检查指标在血栓性血小板减少性紫癜中的诊断价值

Evaluation of the diagnostic value of a number of clinical examination indicators in thrombotic thrombocytopenic purpura

目的应用Logistic回归和ROC曲线探讨多项临床检查指标,如LDH、IBIL、Cr、BUN、D-D、PLT、HGB、SCH、F、NS等对TTP的诊断价值。方法对28例确诊为TTP者及62例疑似而非TTP者(对照组)的血生化、血栓特检、血常规、外周血形态学进行检查,并应用Logistic回归分析,绘制ROC曲线并计算曲线下面积(AUC)来评价各临床检查指标的诊断价值。结果通过比较发现,TTP组的LDH、IBIL、SCH、NS均高于对照组(P<0.05),而PLT、HGB则低于对照组(P<0.05),而F、Cr、BUN、D-D两组间差异无统计学意义(P>0.05)。对有差异的指标进行Logistic回归分析,发现PLT、SCH、NS与TTP的诊断呈独立相关(P<0.05)。对PLT进行ROC曲线分析显示,其诊断TTP的AUC=0.789,约登指数最大时PLT值为15.5×109/L;SCH>2%、PLT<15.5×109/L、NS三项指标独立诊断的准确度分别是84.4%、74.4%、83.3%,SCH>2%、PLT<15.5×109/L两项联合应用后准确度增高值91.1%。结论用于诊断TTP的多项指标中,LDH、IBIL、PLT、HGB、SCH、NS与诊断相关,其中SCH>2%、PLT<15.5×109/L、NS与TTP的诊断又呈独立相关;而BUN、Cr、D-D、F与TTP的诊断相关性不大(P>0.05)。重点关注SCH>2%、PLT<15.5×109/L、NS这三项指标对于TTP的早期诊断和及时治疗,以及降低死亡率有着重要的意义。

Objective Logistic regression and ROC curves were used to explore a number of clinical examination indicators,such as LDH,IBIL,Cr,BUN,D-D,PLT,HGB,SCH,F,NS was used for TTP.Methods Blood biochemistry,thrombosis examination,blood routine,and peripheral blood morphology were examined in 28 patients with confirmed TTP and 62 patients with thrombocytopenia(control group).Logistic regression model was used to plot the ROC curve and calculate the area under the curve(AUC)to evaluate the diagnostic value of a number of linical examination indicators.Results Compared with the control group,the LDH,IBIL,SCH and NS in the TTP group were higher than those in the control group(P<0.05),while the PLT and HGB in the TTP group were lower than those in the control group(P<0.05).However,there was no significant difference in fever,Cr,BUN and D-Dimer between the two groups(P>0.05).Logistic regression was analysed for that different indicators,and it was found that PLT,SCH,NS were independently correlated with TTP(P<0.05).The ROC curve analysis of PLT showed that AUC=0.789,and the PLT value was 15.5×109/L at the maximum of Jordan index.The accuracy of independently the diagnostic of TTP of SCH>2%,PLT<15.5×109/L and NS were 84.4%,74.4%and 83.3%,respectively.After it was combinated by SCH and PLT,the accuracy of the diagnostis of TTP was increased to 91.1%.Conclusion The PLT,SCH,LDH,HGB,IBIL and NS have higher correlation with TTP;PLT,SCH and NS are independently related to the diagnosis of TTP.The Cr,BUN and F was not significant correlation(P>0.05)with the diagnosis of TTP.It is important for early diagnosis and timely treatment to reduce the mortality rate of TTP that SCH,NS and PLT were focused on.