利用ROC曲线分析泪膜破裂时间和泪液分泌试验在干眼症诊断中的应用

目的利用ROC曲线分析的方法,探讨泪膜破裂时间(tear film break up time,BUT)和泪液分泌试验(schirmer test,ST)在诊断干眼症时的最佳临床临界值。方法 122位受访者进行了Saliabury干眼症问卷调查后行BUT检查及ST检查。根据主观干眼症状问卷结果进行干眼症诊断,对BUT及ST客观检验结果分别予ROC曲线统计分析评判。结果从BUT的ROC曲线中我们发现当临界值为5s时,其干眼症诊断的灵敏性为70%以上,特异性60%左右;而当BUT临界值为10秒时,其灵敏性可以达95%,但其特异性仅为25%左右。同样,从ST的ROC曲线中我们发现当临界值为10mm时,其灵敏性为55%以上,特异度63%左右;而当临界值为5mm时,其特异性可以高达95%以上,但其灵敏性仅为20%左右。BUT的ROC曲线下面积大于ST的ROC曲线下面积。结论从ROC曲线分析结果我们认为BUT取5.0s,ST取10mm时其诊断干眼的的灵敏性和特异性组合相对较佳;在诊断干眼时BUT的诊断效能比ST更高。

miRNA-155对慢性心力衰竭的诊断效能及其与β-catenin mRNA通路的相关性研究

目的探讨miRNA-155对慢性心力衰竭(CHF)的诊断效能及其与β-catenin mRNA通路的相关性。方法选择2018年4月至2020年4月金华市中医院收治的CHF患者67例作为观察组,将同期治疗的非CHF心血管疾病患者45例作为对照1组;并选择同期健康体检者39例作为对照2组。采用实时荧光PCR技术测定3组miRNA-155、β-catenin mRNA通路表达水平;绘制ROC曲线,分析miRNA-155、β-catenin mRNA通路表达水平对CHF的诊断效能;并采用Pearson相关对CHF患者miRNA155与β-catenin mRNA通路表达水平的相关性进行分析。结果观察组miRNA-155表达水平(2.78±0.11)高于对照1组(1.43±0.08)和对照2组(0.12±0.02),β-catenin mRNA表达水平(0.23±0.13)低于对照1组和对照2组(0.99±0.06、2.14±0.03),差异均有统计学意义(均P<0.05);对照1组miRNA-155表达水平高于对照2组(P<0.05),β-catenin mRNA表达水平低于对照2组(P<0.05)。miRNA-155、β-catenin mRNA通路联合测定CHF的诊断灵敏度(0.901)、特异度(0.723)均高于单一miRNA-155、β-catenin mRNA通路测定(均P<0.05)。CHF患者miRNA-155表达水平与β-catenin mRNA通路表达水平呈负相关(r=-0.783,P<0.05)。结论miRNA-155在CHF患者中呈高表达,且与β-catenin mRNA通路表达呈负相关,两者联合测定能获得较高的诊断效能,值得推广应用。

弹性成像技术联合甲状腺激素对甲状腺结节的诊断价值

目的:探讨弹性成像技术联合甲状腺激素在甲状腺结节患者中的诊断效果。方法:选择2018年3月至2019年6月疑似甲状腺结节患者88例为观察组,所有患者经穿刺和经甲状腺切除手术组织检查确诊。确诊前患者均完成弹性成像技术测定;采用全自动化学发光法测定患者甲状腺激素(thyroid hormone,TSH)水平。选择同期健康体检者57例为对照组。绘制ROC曲线,分析弹性成像技术联合TSH在甲状腺结节患者中的诊断敏感性、特异性。结果:疑似甲状腺结节患者88例中均经穿刺和手术组织检查确诊,其中良性结节51例(57.95%),恶性结节37例(42.05%)。弹性成像技术最终确诊85例,与手术组织检查诊断符合率为96.59%(P>0.05)。观察组甲状腺结节患者TSH,fT3,fT4及fT3/fT4水平均高于对照组健康体检者(P<0.05);观察组良性结节患者中TSH,fT3,fT4及fT3/fT4水平均低于恶性结节患者(P<0.05)。ROC曲线结果表明:弹性成像技术联合甲状腺激素在甲状腺结节患者诊断敏感性、特异性均高于单一弹性成像技术、甲状腺激素(P<0.05)。结论:弹性成像技术联合甲状腺激素用于甲状腺结节能帮助患者确诊,获得较高的诊断敏感性、特异性。

糖化血红蛋白用于诊断2型糖尿病及糖尿病前期的临床研究

目的：评估糖化血红蛋白（HbA1c）对2型糖尿病（T2DM）及糖尿病前期的诊断价值。方法：为明确糖尿病（DM）诊断而就诊及DM高危人群筛查者共457例，其中男297例，女160例，平均年龄（61．4±13．1）岁，均行口服葡萄糖耐量试验（OGTT），并测定HbA1c。按照1999年WHO糖尿病的诊断标准将受试者分为糖耐量正常（NGT）组81例、空腹血糖受损（IFG）组7例、糖耐量异常（1GT）组76例、IFG＋IGT组13例、DM组280例。采用受试者工作曲线（ROC曲线）来判断其最佳切点。结果：HbA1c诊断DM的切点为6．45％，敏感性为0．794，特异性为0．825，曲线下面积为0．871（95％C10．839—0．903）。HbA1c诊断糖尿病前期的切点为5．85％，敏感性为0．583，特异性为0．531，曲线下面积为0．587（95％C10．504～0．671）。依据HbA1c≥6．45％来诊断糖尿病时，漏诊率为21．1％；应用空腹血糖（FPG）≥7．0mmol／L或HbA1c〉16．45％时，敏感性为0．871，特异性为0．623，漏诊率为12．9％。结论：在筛查T2DM时，同时检测HbA1c和FPG可降低漏诊率。

Evaluation of the diagnostic value of tumor markers with ROC and logistic regression in gastrocolic tumors

Objective: The aim of the study was to evaluate the clinical significance of multiple tumor markers (CEA, AFP, CA72-4 and CA19-9) in patients with gastrocolic tumors by receiver operating characteristic (ROC) curve and stepwise logistic regression (LR) analysis. Methods: The serum concentrations of CEA, AFP, CA72-4 and CA19-9 were measured with electrochemiluminescence immunoassay in 126 patients with gastrocolic tumors, 137 patients with benign gastrocolic disorders and 109 healthy controls. The area under the ROC curve (AUC) of CEA, AFP, CA72-4 and CA19-9 and stepwise LR results were compared by sensitivity, specificity, Youden's index and positive likelihood ratio/negative likelihood ratio. Results: The levels of four tested tumor markers in patients with gastrocolic tumors were significantly higher than those in benign gastrocolic group and normal controls. In the benign gastrocolic group, the AUC from stepwise logistic regression was larger than the AUC of four tumor markers respectively. Sensitivity, Youden's index and positive likelihood ratio/negative likelihood ratio were the highest in the combination assay of CA72-4, CEA, and CA19-9, as compared with one of the tumor markers alone. Conclusion: The use of ROC established by LR analysis model improved the diagnostic accuracy of gastrocolic tumors. For the screening of gastrocolic tumors, the AUC value of the combination probability index (sensitivity and specificity) was significantly higher than the values of the different tumour markers.

尿液对羟基苯丙氨酸和血清胃蛋白酶原联检在胃癌筛查中的意义

目的:探讨尿液对羟基苯丙氨酸和血清胃蛋白酶原(PG)联检在胃癌筛查中的意义。方法:选取2017年1月至2018年12月在武威市人民医院就诊的170例胃癌患者、216例萎缩性胃炎患者为观察组,选取同期150例健康体检者作为健康对照组,分别用化学显色法和化学发光免疫分析法对全部受试者进行尿液对羟基苯丙氨酸和血清PG检测,对各组之间对羟基苯丙氨酸和PG水平进行统计分析。结果:与对照组比较,胃癌组和萎缩性胃炎组的PGⅠ和PGR水平显著降低(P<0.01),对羟基苯丙氨酸和PGⅡ水平显著升高(P<0.01);与萎缩性胃炎组比较,胃癌组的PGⅠ和PGR显著降低(P<0.01),对羟基苯丙氨酸显著升高(P<0.01);胃癌组和萎缩性胃炎组的PGⅡ水平差异无统计学意义(P>0.05)。对羟基苯丙氨酸、PG、对羟基苯丙氨酸+PG诊断胃癌的ROC曲线下面积分别为0.0883、0.834和0.917。结论:尿液对羟基苯丙氨酸和血清PG的联检可实现胃癌的大规模筛查,筛出高危人群,提高了胃镜检查的工作效率,对胃癌的早发现、早诊断、早治疗具有一定的临床意义。

Predicting various outcomes of post-resuscitation comatose survivors： PRCSs Prognostication Score

Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation （CPR） and validate its performance. Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation. A value was assigned to these variables. We used these variables in combination with APACHE II score to devise a multifactorial prediction score system, which we called PRCSs Prognostication Score （PRCSs-PS）. Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS. Score of patients with different outcomes was compared. The area under the receiver- operating characteristic （ROC） curve was determined to evaluate performance of this tool to identify patients with a poor outcome （CPC4 and 5） and other outcomes （CPC1, 2, and 3）. Results There were differences of PRCSs-PS score among multiple groups with five different outcomes （CPC 1-5）（F=65.91, P=0.000）. Pairwise groups with different CPC were compared： no significant difference was noted between CPC1 and CPC2 （12.41±6.49 vs 17.38±6.91,P=0.092）, but difference between other pairwise CPC groups was statistically significant （CPC2 vs CPC3：17.38±6.91 vs 24.50±5.80, P=0.041, CPC3 vs CPC4：24.50±5.80 vs 32.29±5.24, P=0.006）. The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows： it had 100% sensitivity, 78.6% specificity, and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity, 100% specificity and 176.4 diagnostic index at the score cut-off32.5. Score 23 and 33 were two key cut-offpoints. The area under the ROC curve was 0.968, showing excellent discrimination. Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.

化学发光法检测肝纤维化血清学指标的临床应用

目的探讨化学发光法检测肝纤维化指标包括三型前胶原N端肽(PⅢNP)、Ⅳ型胶原(CⅣ)、层粘蛋白(LN)及透明质酸(HA)对肝纤维化的诊断价值。方法用化学发光法检测132例乙型病毒性肝炎患者血清中肝纤维化四项指标的水平,评价四项指标鉴别诊断肝炎及肝硬化的价值。结果乙型肝炎组、肝癌组、肝硬化组血清中的四项指标依次升高,均与正常对照组差异有统计学意义(P<0.01)。ROC曲线显示,PⅢNP、CIV、LN、HA的曲线下面积分别为0.680、0.825、0.716、0.825,灵敏度分别为39.1%、87.0%、87.0%、82.6%,特异性分别为89.8%、69.3%、53.4%、86.4%,准确性分别为79.09%、72.73%、78.18%、85.45%。在联合检测中,HA+PⅢNP组合的灵敏度为83.0%,特异性为80.0%,准确性为80.1%。结论单个指标检测,HA是四项指标中鉴别诊断肝炎与肝硬化最有价值的一项,通过HA联合其他指标进行分析,其中HA+PⅢNP组合特异性、准确性最高。