应用ROC曲线评价MIP-1α在煤工尘肺早期诊断中的价值

Evaluation of MIP-1α Detection in Eearly Diagnosis of Coal Workers' Pneumoconiosis by Receiver Operating Characteristic Curve Analysis

  • 摘要:
    目的 构建受试者工作特征(ROC)曲线模型,应用ROC曲线探讨血清巨噬细胞炎症蛋白-1α(MIP-1α)在煤工尘肺病早期诊断中的价值。

    方法 选择某煤业集团公司经职业健康检查的、肺部有小阴影但不够诊断为尘肺一期的180 名接尘工人作为观察组,180 名肺部完全正常的接尘工人作为接尘组,109 名煤工尘肺一期患者作为病例组,采集空腹静脉血,使用酶联免疫吸附法测定3 组研究对象血清中趋化因子MIP-1α 的表达水平,采用ROC 曲线对MIP-1α 筛检煤工尘肺的作用进行评价。

    结果 经协方差分析,控制年龄因素的影响后,病例组MIP-1α 的表达水平均高于接尘组和观察组,差异均有统计学意义(P<0.05),观察组MIP-1α 的表达水平高于接尘组,差异有统计学意义(P<0.05)。对接尘工龄分层后进行分析,结果表明病例组在10~ 年、20~ 年和30~38 年3 个工龄段MIP-1α 表达水平均高于观察组和接尘组,差异均有统计学意义(P<0.05),观察组在10~ 年、20~ 年和30~38 年3 个工龄段MIP-1α 表达水平均高于接尘组,差异均有统计学意义(P<0.05);病例组、观察组和接尘组MIP-1α 表达水平随着工龄的增加有增高趋势。构建ROC曲线,曲线下面积为0.874,最佳界值为940.85 ng/L,灵敏度为75.2%,特异度为90.0%,漏诊率为24.8%、误诊率为10%、约登指数为65.2%、阳性似然比为7.52、阴性似然比为0.28、符合率为0.87、Kappa 值为0.63、阳性预测值为69.49%、阴性预测值为92.31%,收益是36 人。

    结论 经ROC曲线评价,MIP-1α 作为筛检指标具有较高的真实性和可靠性,在煤工尘肺早期诊断中具有较高的参考价值。

     

    Abstract:
    Objective To explore the value of macrophage inflammatory protein-1α (MIP-1α) in early diagnosis of coal workers' pneumoconiosis by establishing a receiver operating characteristic (ROC) curve model.

    Methods Serum levels of MIP-1α were determined by enzyme-linked immunosorbent assay (ELISA) in 180 suspected silicosis patients with small lung opacity (observation group), 180 silica dust exposed workers without pneumoconiosis (dust exposed group), and 109 stage Ⅰ pneumoconiosis patients (case group). Evaluation of serum MIP-1α detection in screening coal workers' pneumoconiosis was using ROC curve analysis.

    Results By analysis of covariance, controlling for age, the serum levels of MIP-1α in the case group were significantly higher than those in the exposed group and the observation group (P<0.05); and the levels of MIP-1α in the observation group were significantly higher than those in the exposed group (P<0.05). When stratified by seniority, the levels of MIP-1α in the case group were significantly higher than those in the observation group or in the exposed group for dust exposure duration of 10-years, 20-years, or 30 to 38 years (P<0.05); the levels of MIP-1α in the observation group were significantly higher than those in the exposed group for the above three durations (P<0.05). The MIP-1α level increased with seniority for the three groups. The ROC analysis indicated the area under the ROC curve was 0.874, the optimal criterion value was 940.85 ng/L, the sensitivity was 75.2%, the specificity was 90.0%, the missed diagnosis rate was 24.8%, the misdiagnosis rate was 10%, the Youden index was 65.2%, the positive likelihood ratio was 7.52, the negative likelihood ratio was 0.28, the agreement was 0.87, the Kappa value was 0.63, the positive predictive value was 69.49%, the negative predictive was 92.31%, and the yield was 36 people.

    Conclusion MIP-1α as a screening indicator has the advantages in high validity and reliability, and therefore can be used for coal workers' pneumoconiosis early diagnosis.

     

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