肝生化指标在燃煤型砷中毒中诊断价值ROC曲线评价

目的 应用受试者工作特征曲线(ROC曲线)探讨肝生化指标在燃煤型砷中毒中的诊断价值。方法 2014年1月以贵州省兴仁县燃煤型砷中毒病区为调查点,采用生物化学法检测调查对象肝生化指标。绘制ROC曲线并计算曲线下面积(AUC)。结果 砷中毒组血清总蛋白(TP)、白蛋白(ALB)含量和白球比(A/G)均低于对照组(P < 0.01),碱性磷酸酶(ALP)活性和总胆汁酸(TBA)含量均高于对照组(P < 0.05);中、重度砷中毒组血清谷氨酰胺转移酶(γ-GT)高于对照组(P < 0.05);与对照比较,轻度组ALB、A/G、TBA 、TP、ALP的 AUC分别为0.79、0.71、0.64、0.63、0.60(P < 0.05);敏感度A/G>ALP>ALB>TBA>TP;中度组ALB、TBA、A/G、TP、ALP、γ-GT的AUC值分别为0.86、0.81、0.76、0.67、0.61、0.59(P < 0.05),TBA > ALB > A/G > ALP > TP > γ-GT。重度组ALB、TBA、A/G、TP、ALP、γ-GT的AUC值分别为0.89、0.87、0.79、0.72、0.67、0.63(P < 0.01),TBA > A/G > ALB > TP > ALP > γ-GT。结论 ALB、TBA含量和A/G有助于砷中毒的早期诊断及分度诊断;TP、ALP、γ-GT可作为砷中毒辅助诊断和分度诊断的参考指标。

Significance of liver biochemical indexes in diagnose of coal-burning arsenism:receiver operating characteristic curve analysis

Objective To explore the significance of liver biochemical indexes in the diagnosis of coal-burning arsenism with receiver operating characteristic(ROC)curve analysis.Methods Totally 307 arsenic poisoning patients and 84 healthy persons with normal liver function were recruited as cases and controls from Xingren county(an endmic area of coal-burning arsenism)in Guizhou province in January 2014.Biochemical methods were used to measure liver biochemical indexes of the participants.The significance of the liver indexes in the diagnosis of coal-burning arsenism was evaluated by calculating the area under the ROC curve (AUC).Results Compared with those in the controls,the concentration of total protein (TP) and albumin (ALB) and the ratio of albumin and globulin (A/G)in the cases were all decreased (all P < 0.01),while the activity of alkaline phosphatase (ALP) and the level of total bile acid (TBA) were increased (both P < 0.05).The activity of γ-glutamyl transpeptidase (γ-GT) in the cases with moderate and severe arsenism were higher than that in the controls (P < 0.05).For the cases with mild arsenism,the AUC of ALB,A/G,TBA,TP and ALP are 0.79,0.71,0.64,0.63,and 0.60 and all the AUC values are statistically significant (all P < 0.05);the sensitivity of the indexes ranks with a decreasing order of A /G,ALP,ALB,TBA,and TP.For the cases with moderate arsenism,the AUC of ALB,A/G,TBA,TP,ALP,and γ-GT are 0.86,0.81,0.76,0.67,0.61,and 0.59 (all P < 0.05) and the sensitivity of the indexes ranks with a decreasing order of ALB,TBA,A/G,TP,ALP,and γ-GT.For the cases with severe arsenism,the AUC of ALB,A/G,TBA,TP,ALP,and γ-GT are 0.89,0.87,0.79,0.72,0.67,and 0.63 (all P < 0.01) and the sensitivity of the indexes ranks with a decreasing order of ALB,TBA,A/G,TP,ALP,and γ-GT.Conclusion Serum ALB,TBA and A/G ratio may be significant biomarkers for the early diagnosis of arsenism and could be predictors for the severity arsenism.In addition,TP,ALP and γ-GT may be adopted as references for auxiliary and grading diagnosis of arsenism.