影像学与实验室检测指标联合诊断尘肺结核的价值分析

发布时间：2017-12-31 00:51

本文关键词：影像学与实验室检测指标联合诊断尘肺结核的价值分析　出处：《华北理工大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的通过对比分析尘肺结核组与尘肺非结核组影像学及实验室检测指标的差异,筛选尘肺结核的特征性指标,评价各指标独立和联合应用时诊断尘肺结核的临床意义,为临床减少诊断性治疗,提高诊断效率提供科学依据。方法实验室检测由医院检验科完成,研究生负责数据采集,填写调查表。影像学检查结果由资深医师指导确定,制作调查表,按照调查表的要求记录检查结果。所得资料用Epidata3.1建立数据库,采用SPSS18.0统计软件包进行统计学处理。单因素分析(即组间比较)采用t检验或卡方检验,多因素筛选采用Logistic回归模型;计量资料进行相关回归分析,计数资料进行一致性分析;计算筛选出的各指标的灵敏度、特异度、约登指数、kappa值,采用ROC曲线进行比较;根据指标独立使用时的灵敏度和特异度,确定联合试验的类型(串联试验或并联试验);计算不同指标组合时的灵敏度、特异度、约登指数、kappa值及ROC曲线下的面积,确定联合试验的类型及最佳组合。结果1 C反应蛋白诊断尘肺结核的最佳临界值(cutoff值)为6.5,其灵敏度为71%,特异度为85%,约登指数(YI)为0.56,与尘肺结核分组的秩相关系数为0.566(P0.01),C反应蛋白诊断尘肺结核ROC曲线的曲线下面积(AUC)为0.801;γ-干扰素释放试验灵敏度为86%,特异度为53%,YI为0.39,kappa值为0.39(P0.01),AUC=0.695;ASSURE TB Rapid灵敏度为48%,特异度为89%,YI为0.37,kappa值为0.37(P0.01),AUC=0.685;影像学空洞表现灵敏度为36%,特异度为98%,YI为0.34,kappa值为0.34(P0.01),AUC=0.670;影像学片状表现灵敏度为73%,特异度为56%,YI为0.29,kappa值为0.29(P0.01),AUC=0.645;影像学团块表现灵敏度为30%,特异度为91%,YI为0.21,kappa值为0.21(P0.01),AUC=0.6052诊断效率最佳的组合模型为影像学空洞、团块、片状并联方案与实验室检查C反应蛋白、γ-干扰素释放试验并联方案进行串联,结果显示此法的灵敏度为92%,特异度为74%,约登指数(YI)为0.66,kappa值为0.66(P0.01),ROC曲线下面积(AUC)为0.825。结论1各诊断方法单独使用的诊断效率从高到低排序为C反应蛋白、γ-干扰素释放试验、ASSURE TB R apid、影像学空洞表现、影像学片状表现、影像学团块表现。2诊断效率最佳的组合模型为影像学空洞、团块、片状并联方案与实验室检查C反应蛋白、γ-干扰素释放试验并联方案进行串联。
[Abstract]:Objective through the comparative analysis of pneumoconiosis tuberculosis and pneumoconiosis group differences non tuberculosis group imaging and laboratory indexes, index screening of tuberculosis, clinical significance in diagnosis of pneumoconiosis tuberculosis evaluation indexes of independent and combined application, to reduce clinical diagnostic treatment, provide scientific basis for improving the efficiency of diagnosis. Methods by laboratory testing the hospital laboratory, graduate is responsible for data collection and questionnaire. The results of imaging examination by senior physician guidance, making questionnaire, according to the inspection results recorded data obtained from the questionnaire. The database was established by Epidata3.1, using SPSS18.0 statistical software for statistical analysis. Single factor analysis (i.e., comparison between groups using t test or chi) square test, multiple factors were screened by Logistic regression model; correlation regression analysis of measurement data, count data consistency analysis meter; The sensitivity of each index is selected the specificity and Youden index, kappa value, ROC curve is used to compare; according to the sensitivity and specificity of independent use, determine the type of joint test (test series or parallel test); index calculation of different combinations of sensitivity, specificity and Youden index, kappa value and the area under the ROC curve, determine the type of joint test and the best combination of the best results. The critical 1 C reactive protein in diagnosis of pneumoconiosis tuberculosis value (cutoff value) was 6.5, the sensitivity was 71%, specificity was 85%, Youden index (YI) was 0.56, and the rank correlation coefficient is 0.566 (group of pneumoconiosis tuberculosis P0.01), C reactive protein in diagnosis of pneumoconiosis tuberculosis area under curve ROC (AUC) 0.801; interferon gamma release test sensitivity was 86%, specificity was 53%, YI was 0.39, kappa was 0.39 (P0.01), AUC=0.695 ASSURE TB Rapid; the sensitivity was 48%, specificity was 8. 9%, YI was 0.37, kappa was 0.37 (P0.01), AUC=0.685; imaging performance of cavity sensitivity was 36%, specificity was 98%, YI was 0.34, kappa was 0.34 (P0.01), AUC=0.670; imaging sheet performance sensitivity was 73%, specificity was 56%, YI was 0.29, kappa value is 0.29 (P0.01, AUC=0.645); imaging performance of mass sensitivity was 30%, specificity was 91%, YI was 0.21, kappa was 0.21 (P0.01), a combination of the optimal model of the AUC=0.6052 diagnostic efficiency for the imaging hole, mass, flake parallel scheme and laboratory examination of C reactive protein, interferon gamma release test in parallel program the results show that the series, the sensitivity was 92%, specificity was 74%, Youden index (YI) was 0.66, kappa was 0.66 (P0.01), the area under the ROC curve (AUC) using a separate diagnostic efficiency was 0.825. conclusion 1 diagnosis methods from high to low sort of C reactive protein, interferon gamma release ASSURE TB R apid test. The best combination model of imaging cavity performance, imaging slice appearance, imaging mass and.2 diagnosis efficiency is imaging cavity, lump, flake parallel scheme, and laboratory test C reactive protein, gamma interferon release test parallel scheme in series.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R135.2;R521

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