血清皮质醇鉴别亚健康状态价值评价

目的 评价血清皮质醇用于鉴别亚健康状态的价值。方法 以首都医科大学附属宣武医院体检中心的体检人群作为研究对象，进行问卷调查，采集静脉血检测血清皮质醇和儿茶酚胺，以潜类别数为2拟合潜在分类模型，利用EM算法对潜类别概率和潜类别下各指标的条件概率进行估计，计算各指标的灵敏度与特异度并确定判断界值。结果 模型的CAIC为67.02，AIC为28.14，这2个指标都比较小，说明模型拟合较好。3个评价指标中，血清皮质醇的诊断价值最高，灵敏度与特异度分别为0.778 1（95%：0.747 4~0.808 8）与0.964 4（95%CI：0.950 7~0.978 1），判定的界值为179 ng/mL。亚健康问卷的灵敏度与特异度分别为0.7363（95%CI：0.703 7~0.768 9）和0.701 7（95%CI：0.667 9~0.735 5），判定的界值为25分。血清儿茶酚胺灵敏度和特异度分别为0.602 5（95%CI：0.566 3~0.638 7）和0.522 3（95%CI：0.485 3~0.559 3）。结论 血清皮质醇是用于判定亚健康状态的一个较好的指标，而亚健康调查问卷更适合用于亚健康人群的筛查。

Significance of serum cortisol in identification of suboptimal health state among physical examinees

Objective To evaluate the significance of serum cortisol in identification of suboptimal health state(SHS).Methods Totally 702 physical examinees aged 18-60 years and without serious diseases were recruited at Xuanwu Hospital of Capital Medical University and surveyed with a self-designed SHS questionnaire (SHSQ) and serum cortisol and catecholamine detection between March to July 2012.Latent class method was used to evaluate the significance of the variables in identifying SHS.Probabilities of latent categories and conditional probability of the indicators were estimated by using expectation-maximization (EM) algorithm and the sensitivity,specificity,and critical value of the indicator were calculated.Results The established latent potential classification model showed a good fitness,with the consistent Akaike's information criterion (CAIC) of 67.02 and Akaike information criterion (AIC) of 28.14.The sensitivity and specificity of serum cortisol were 0.7781(95% confidence interval[95%CI]:0.747 4-0.808 8)and 0.964 4(95%CI:0.950 7-0.978 1),respectively.The sensitivity and specificity of the SHSQ were 0.736 3(95%CI:0.703 7-0.768 9)and 0.701 7(95%CI:0.667 9-0.735 5),respectively.Conclusion Serum cortisol is a good indicator for identifying SHS.The SHSQ is more suitable for the screening of SHS.