• 南通大學(xué)附屬醫(yī)院消化病研究室（江蘇南通，226001）;

【摘要】　目的　 應(yīng)用受試者工作特征曲線（receiver operating characteristic curve，ROC曲線）探討α-L-巖藻糖苷酶（AFU）對(duì)惡性腹水和非結(jié)核良性腹水的診斷價(jià)值。　方法　 2004年7月—2008年1月對(duì)213例診斷明確的良、惡性腹水（其中良性腹水117例、惡性腹水96例）AFU活性進(jìn)行檢測。采用ROC曲線評(píng)價(jià)AFU的診斷靈敏度、特異度、準(zhǔn)確性、陽性預(yù)測值、陰性預(yù)測值、陽性似然比、陰性似然比及Youden指數(shù)，評(píng)價(jià)其診斷效率。　結(jié)果　 惡性腹水組AFU水平（164.96±87.72） μmol/（L?h），良性腹水組（104.02±62.07） μmol/（L?h），兩者比較差異有統(tǒng)計(jì)學(xué)意義（P lt;0.01）。AFU診斷惡性腹水的ROC 曲線下面積為0.754±0.034，最佳分界值101.95 μmol/（L?h）。以AFU≥101.95 μmol/（L?h）來預(yù)測惡性腹水，其診斷的靈敏度為82.3%，特異度為63.2%，準(zhǔn)確性為72.8%、陽性預(yù)測值為65.3%、陰性預(yù)測值為83.1%、陽性似然比為2.23、陰性似然比為0.28及Youden指數(shù)為0.455。　結(jié)論　 腹水AFU活性檢測有助于惡性腹水和非結(jié)核良性腹水的鑒別診斷，是一個(gè)比較理想的實(shí)用指標(biāo)，適合于基層醫(yī)院的臨床應(yīng)用。
【Abstract】　Objective　 To assess the value of α-L-fucosidase (AFU) levels with receiver operating characteristic curve (ROC curve) in the diagnosis of malignant and non-tuberculous benign ascites. 　Methods　 Ascitic AFU activity was measured in 213 patients (117 with benign ascites and 96 with malignant ascites) diagnosed with benign or malignant ascites. The diagnostic sensitivity (SEN), specificity (SPE), accuracy, positive predictive value (PV+), negative predictive value (PV-), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and Youden index (YI) of AFU were assessed with receiver operating characteristic curve, and the diagnostic effectiveness of AFU was evaluated. 　Results　 The average level of AFU in the malignant group [(164.96±87.72) μmol/(L?h)] was significantly higher than that in the benign group [(104.02±62.07) μmol/(L?h)] (P lt;0.01). The area under the curve (AUC) of the ROC curve of AFU was 0.754±0.034 for malignant ascites diagnosis, and the optimal cut-off value was 101.95 μmol/(L?h). When an AFU level equal to or higher than 101.95 μmol/(L?h) was used to predict malignant ascites, the diagnostic sensitivity was 82.3%, specificity was 63.2%, accuracy was 72.8%, PV+ was 65.3%, PV- was 83.1%, LR+ was 2.23, LR- was 0.28 and YI was 0.455. 　Conclusion　 Detection of AFU activity in ascites is helpful to differentiate the diagnose between malignant and non-tuberculous benign ascites, which is a relatively ideal index to fit for clinical application of local hospitals.

引用本文： 李峰,魏群,朱郁飛,張弘. 應(yīng)用受試者工作特征曲線評(píng)價(jià)α-L-巖藻糖苷酶對(duì)良惡性腹水的診斷價(jià)值. 華西醫(yī)學(xué), 2011, 26(5): 660-662. doi: 復(fù)制

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11. 　傅麗娟, 趙宏偉, 任燕, 等. 肝臟炎癥對(duì)AFU診斷肝癌價(jià)值的影響[J]. 中國現(xiàn)代醫(yī)生, 2009, 47(16): 52-53.
  1. 1. 　Greco AV, Mingrone G, Gasbarrini G. Free fatty acid analysis in ascitic fluid improves diagnosis in malignant abdominal tumors [J]. Clin Chim Acta, 1995, 239 (1): 13-22.
  2. 2. 　Runyon BA. Care of patient with ascites [J]. N Engl J Med, 1994, 330(5): 337-342.
  3. 3. 　王露霞, 石凌波, 成德,等. 用ROC曲線評(píng)價(jià)血清甘露聚糖抗原檢測法對(duì)深部念珠菌感染的診斷值[J]. 第三軍醫(yī)大學(xué)學(xué)報(bào), 2007, 29 (7): 646.
  4. 4. 　Obuchowski NA. Receiver operating characteristic curves and their use in radiology[J]. Radiology, 2003, 229(1): 3-8.
  5. 5. 　黃唯, 龔飛躍. 血清生化指標(biāo)對(duì)乙型肝炎肝硬化的診斷價(jià)值[J]. 第一軍醫(yī)大學(xué)學(xué)報(bào), 2002, 22(11): 1034-1036.
  6. 6. 　Swets JA. Measuring the accuracy of diagnostic systems [J]. Science, 1988, 240(4857): 1285-1293.
  7. 7. 　熊立凡, 王鴻利. 循證檢驗(yàn)醫(yī)學(xué)能為臨床醫(yī)學(xué)提供決策和證據(jù)[J]. 中國實(shí)驗(yàn)診斷學(xué), 2004, 8(1): 82-85.
  8. 8. 　徐焰, 陳名聲, 郝曉柯. 聯(lián)合檢測血清AFU、AFP 腫瘤標(biāo)志物在原發(fā)性肝癌診斷中的臨床價(jià)值[J]. 重慶醫(yī)學(xué), 2008, 37(24): 2805-2806.
  9. 9. 　Wright LM, Kreikemeier JT, Fimmel CJ. A concise review of serum markers for hepatocellular cancer[J]. Cancer Detect Prev, 2007, 31(1): 35-44.
  10. 10. 　Giardina MG, Matarazzo M, Morante R, et al. Serum alpha-L-fucosidase activity and early detection of hepatocellular carcinoma: a prospective study of patients with cirrhosis[J]. Cancer,1998, 83(12): 2468-2474.
  11. 11. 　傅麗娟, 趙宏偉, 任燕, 等. 肝臟炎癥對(duì)AFU診斷肝癌價(jià)值的影響[J]. 中國現(xiàn)代醫(yī)生, 2009, 47(16): 52-53.