摘要
目的研究ROC曲线分析在特发性性早熟(idiopathic precocious puberty,IPP)女孩骨龄诊断中的实用价值。方法参照“金标准”选择特发性性早熟患儿55例,年龄为3．2岁-9．9岁(7．55±1．90) 岁。对照组包括:A组。10岁以后月经初潮者为14例,平均年龄为(11．45±1．05)岁;B组。8岁-10岁,体重偏轻者25例,平均年龄为(9．2±0．67)岁;C组。8岁-10岁,体重正常者32例,平均年龄为(9．11± 0．74)岁;D组。8岁-10岁,体重偏重者12例,平均年龄为(9．61±0．66)岁。回顾性分析初诊时,第一张左手腕X光片,用TW2法盲法分期,骨龄结果分为13骨骨龄、7骨骨龄和20骨骨龄3个系统,每个系统设5 个工作点,即(1)>P97、(2)>P90、(3)>P75、(4)>P50和(5)≤P50。结果敏感度和特异度都比较高的有以下4个工作点:(1)13骨骨龄的“>P90”点(Sen=0．836,Spe=0．916);(2)7骨骨龄的“>P90”点 (Sen=0．746,Spe=0．916);(3)20骨骨龄的“>P90”点(Sen=0．746,Spe=0．964);(4)“>P75”点(Sen= 0．982,Spe=0．783)。3条ROC曲线下面积分别为:(1)13骨骨龄A13为0．939±0．019(95％CI为0．902- 0．977);(2)7骨骨龄A7为0．899±0．028(95％CI为0．845-0．954);(3)20骨骨龄A20为0．958±0．014 (95％Cl为0．930-0．986)。结论 13骨骨龄和20骨骨龄诊断性早熟有高度准确性;“13骨骨龄>P90”工作点为综合考虑了敏感度和特异度之后最佳的一点,故确定为诊断性早熟的正常值临界点。
Objective To investigate the diagnostic value of the receiver operating characteristic (ROC) curve analysis of bone age for female idiopathic precocious puberty. Methods Fifty-five girls aged 3. 2 - 9. 9(7. 55±1. 90) years with idiopathic precocious puberty were enrolled. Among them 36 cases under 8 (6. 07±1. 72) years old had breast development; 20 cases aged 5. 0-9. 75 (8. 75±1. 26) years experienced menophania. Four control groups were designed: Control group A had 14 cases over 10 (11.45±1.05) years old with menophania; Control group B 25 cases aged 8 - 9 (9. 2±0. 67) years with low-weight; Control group C 32 cases aged 8-10 (9. 11±0. 74) years with normal weight; Control group D 12 cases aged 8-10 (9. 61±0. 66) years with over-weight. The first radiographs of the left hand and wrist were used for bone age estimation with a single-blind analysis using the Tanner and Whitehouse (TW2) methods. Systems of RUS, carpal , and 20 bones were used for bone ages. Five decision thresholds were set in each system. Results Four points were relatively high for both sensitivity and specificity: (l)RUS of '>P90'(Sen = 0. 836, Spe = 0. 916), (2)carpale of '>P90'(Sen = 0. 746, Spe = 0. 916),(3) 20 bone of '>P90'(Sen = 0. 746, Spe = 0. 964) and (4) '>P75'(Sen = 0. 982,Spe = 0. 783); For the area under a ROC curve, RUS of A13 = 0.939±0. 019 (95%CI:0. 902-0. 977), carpale of A7= 0.899±0. 028 (95%CI:0. 845 - 0. 954), 20 bone of A20 = 0. 958±0. 014 (95%CI:0. 930-0. 986), F = 2. 03,P = 0. 13. Conclusion The bone age of RUS and 20 bones were high in accuracy for diagnosing idiopathic precocious puberty. The decision threshold of RUS of '>P90' was the best diagnostic point when both sensitivity and specificity were considered.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2005年第1期15-19,共5页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
关键词
ROC曲线分析
性早熟
女孩
骨龄
评价
诊断
age determination by skeleton
idiopathic precocious puberty
receiver operating characteristic (ROC) curve
