摘要
目的分析受试者工作特征曲线(ROC曲线)对选择胃癌肿瘤标志物最佳截断值的临床应用价值。方法将郎溪县人民医院2020年1月—2022年12月收治的60例胃癌患者纳入胃癌组,另外选择同期60例胃部良性病变患者和60例健康体检者分别纳入胃病组和对照组。采用化学发光法检测癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和糖类抗原72-4(CA72-4),比较各组不同指标的阳性率;绘制ROC曲线并计算ROC曲线下面积(AUC),选择CEA、CA19-9和CA72-4的最佳截断值并计算在此截断值下不同指标单独及联合检测对胃癌的诊断效能。结果胃癌组CEA、CA19-9和CA72-4阳性率均明显高于对照组(CEA:55.00%比0.00%;CA19-9:50.00%比0.00%;CA72-4:46.67%比0.00%;均P<0.05)。CEA、CA19-9和CA72-4单独及联合检测诊断胃癌的约登指数分别为0.517、0.458、0.442、0.617;ROC曲线显示,CEA[AUC为0.838,95%可信区间(95%CI)为0.770~0.907]、CA19-9(AUC为0.836,95%CI为0.769~0.902)和CA72-4(AUC为0.855,95%CI为0.796~0.914)对胃癌的诊断效能均较高,三项指标联合应用效果更好(AUC为0.946,95%CI为0.909~0.984);CEA、CA19-9、CA72-4的最佳截断值分别为5.77μg/L、29.52 kU/L、5.06 kU/L,在此截断值时CEA、CA19-9和CA72-4单独及联合检测诊断胃癌的约登指数分别为0.616、0.625、0.641和0.816。结论CEA、CA19-9和CA72-4对胃癌均有较高的诊断价值,多指标联合应用和建立适合实验室的最佳截断值可进一步提高其诊断效能,为临床对胃癌的早期诊断和及时治疗提供参考依据。
Objective To analyze the clinical application value of receiver operator characteristic(ROC)curve in selecting optimal cutoff value for gastric cancer tumor markers.Methods Sixty patients diagnozed with gastric cancer and admitted to Langxi County People's Hospital from January 2020 to December 2022 were selected as research objects and included in gastric cancer group.In addition,60 patients with benign gastric lesions and 60 healthy examinees during the same period were included in gastric disease group and control group.Chemiluminescence was used to detect carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),and carbohydrate antigen 72-4(CA72-4),and the positive rates of different indicators in each group were compared.The ROC curve was drawn and the area under ROC curve(AUC)was calculated.The optimal cutoff values for CEA,CA19-9 and CA72-4 were selected,and the diagnostic efficacies of different indicators for gastric cancer under these cutoff values both individually and in combination were calculated.Results The positive rates of CEA,CA19-9 and CA72-4 in gastric cancer group were significantly higher than those in control group(CEA:55.00%vs.0.00%;CA19-9:50.00%vs.0.00%;CA72-4:46.67%vs.0.00%;all P<0.05).The Jordan indices for diagnosing gastric cancer using CEA,CA19-9,CA72-4 alone and in combination were 0.517,0.458,0.442 and 0.617,respectively.The ROC curve showed that CEA[AUC was 0.838,95%confidence interval(95%CI)was 0.770-0.907],CA19-9(AUC was 0.836,95%CI was 0.769-0.902)and CA72-4(AUC was 0.855,95%CI was 0.796-0.914)had high diagnostic efficacies for gastric cancer,and the combined use of three indicators was more effective(AUC was 0.946,95%CI was 0.909-0.984).The optimal cutoff values for CEA,CA19-9 and CA72-4 were 5.77μg/L,29.52 kU/L and 5.06 kU/L,respectively.At these cutoff values,the Jordan indices for differential diagnosis of gastric cancer using CEA,CA19-9 and CA72-4 alone and in combination were 0.616,0.625,0.641 and 0.816,respectively.Conclusion CEA,CA19-9 and CA72-4 all have high diagnostic value for gastric cancer,and the combination of multiple indicators and the establishment of the optimal cutoff value suitable for the laboratory could further improve the diagnostic efficiency,providing reference basis for early diagnosis and timely treatment of gastric cancer in clinical practice.
作者
徐进
张青松
孙斗智
Xu Jin;Zhang Qingsong;Sun Douzhi(Department of Clinical Laboratory,Langxi County People's Hospital,Xuancheng 242199,Anhui,China;Department of Clinical Laboratory,Xuancheng Central Hospital,Xuancheng 242000,Anhui,China)
出处
《实用检验医师杂志》
2024年第1期19-22,共4页
Chinese Journal of Clinical Pathologist
基金
安徽省宣城市卫生健康科研项目(XCWJ2022061)。
关键词
受试者工作特征曲线
胃癌
肿瘤标志物
最佳截断值
应用价值
Receiver operator characteristic curve
Gastric cancer
Tumor marker
Optimal cutoff value
Application value
