应用受试者工作特征曲线评价α-L-岩藻糖苷酶对良恶性腹水的诊断价值

【】　目的　应用受试者工作特征曲线（receiveroperatingcharacteristiccurve，ROC曲线）探讨α-L-岩藻糖苷酶（AFU）对恶性腹水和非结核良性腹水的诊断价值。　方法　2004年7月―2008年1月对213例诊断明确的良、恶性腹水（其中良性腹水117例、恶性腹水96例）AFU活性进行检测。采用ROC曲线评价AFU的诊断灵敏度、特异度、准确性、阳性预测值、阴性预测值、阳性似然比、阴性似然比及Youden指数，评价其诊断效率。　结果　恶性腹水组AFU水平（164.96±87.72）μmol/（L?h），良性腹水组（104.02±62.07）μmol/（L?h），两者比较差异有统计学意义（P<0.01）。AFU诊断恶性腹水的ROC曲线下面积为0.754±0.034，最佳分界值101.95μmol/（L?h）。以AFU≥101.95μmol/（L?h）来预测恶性腹水，其诊断的灵敏度为82.3%，特异度为63.2%，准确性为72.8%、阳性预测值为65.3%、阴性预测值为83.1%、阳性似然比为2.23、阴性似然比为0.28及Youden指数为0.455。　结论　腹水AFU活性检测有助于恶性腹水和非结核良性腹水的鉴别诊断，是一个比较理想的实用指标，适合于基层医院的临床应用。【Abstract】　Objective　Toassessthevalueofα-L-fucosidase(AFU)levelswithreceiveroperatingcharacteristiccurve(ROCcurve)inthediagnosisofmalignantandnon-tuberculousbenignascites.　Methods　AsciticAFUactivitywasmeasuredin213patients(117withbenignascitesand96withmalignantascites)diagnosedwithbenignormalignantascites.Thediagnosticsensitivity(SEN),specificity(SPE),accuracy,positivepredictivevalue(PV+),negativepredictivevalue(PV-),positivelikelihoodratio(LR+),negativelikelihoodratio(LR-)andYoudenindex(YI)ofAFUwereassessedwithreceiveroperatingcharacteristiccurve,andthediagnosticeffectivenessofAFUwasevaluated.　Results　TheaveragelevelofAFUinthemalignantgroup(164.96±87.72)μmol/(L?h)wassignificantlyhigherthanthatinthebenigngroup(104.02±62.07)μmol/(L?h)(P<0.01).Theareaunderthecurve(AUC)oftheROCcurveofAFUwas0.754±0.034formalignantascitesdiagnosis,andtheoptimalcut-offvaluewas101.95μmol/(L?h).WhenanAFUlevelequaltoorhigherthan101.95μmol/(L?h)wasusedtopredictmalignantascites,thediagnosticsensitivitywas82.3%,specificitywas63.2%,accuracywas72.8%,PV+was65.3%,PV-was83.1%,LR+was2.23,LR-was0.28andYIwas0.455.　Conclusion　DetectionofAFUactivityinascitesishelpfultodifferentiatethediagnosebetweenmalignantandnon-tuberculousbenignascites,whichisarelativelyidealindextofitforclinicalapplicationoflocalhospitals.