本文關(guān)鍵詞：影像學(xué)與實(shí)驗(yàn)室檢測(cè)指標(biāo)聯(lián)合診斷塵肺結(jié)核的價(jià)值分析　出處：《華北理工大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 塵肺 塵肺結(jié)核 診斷方法 ROC曲線 聯(lián)合試驗(yàn)

【摘要】：目的通過對(duì)比分析塵肺結(jié)核組與塵肺非結(jié)核組影像學(xué)及實(shí)驗(yàn)室檢測(cè)指標(biāo)的差異,篩選塵肺結(jié)核的特征性指標(biāo),評(píng)價(jià)各指標(biāo)獨(dú)立和聯(lián)合應(yīng)用時(shí)診斷塵肺結(jié)核的臨床意義,為臨床減少診斷性治療,提高診斷效率提供科學(xué)依據(jù)。方法實(shí)驗(yàn)室檢測(cè)由醫(yī)院檢驗(yàn)科完成,研究生負(fù)責(zé)數(shù)據(jù)采集,填寫調(diào)查表。影像學(xué)檢查結(jié)果由資深醫(yī)師指導(dǎo)確定,制作調(diào)查表,按照調(diào)查表的要求記錄檢查結(jié)果。所得資料用Epidata3.1建立數(shù)據(jù)庫,采用SPSS18.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)學(xué)處理。單因素分析(即組間比較)采用t檢驗(yàn)或卡方檢驗(yàn),多因素篩選采用Logistic回歸模型;計(jì)量資料進(jìn)行相關(guān)回歸分析,計(jì)數(shù)資料進(jìn)行一致性分析;計(jì)算篩選出的各指標(biāo)的靈敏度、特異度、約登指數(shù)、kappa值,采用ROC曲線進(jìn)行比較;根據(jù)指標(biāo)獨(dú)立使用時(shí)的靈敏度和特異度,確定聯(lián)合試驗(yàn)的類型(串聯(lián)試驗(yàn)或并聯(lián)試驗(yàn));計(jì)算不同指標(biāo)組合時(shí)的靈敏度、特異度、約登指數(shù)、kappa值及ROC曲線下的面積,確定聯(lián)合試驗(yàn)的類型及最佳組合。結(jié)果1 C反應(yīng)蛋白診斷塵肺結(jié)核的最佳臨界值(cutoff值)為6.5,其靈敏度為71%,特異度為85%,約登指數(shù)(YI)為0.56,與塵肺結(jié)核分組的秩相關(guān)系數(shù)為0.566(P0.01),C反應(yīng)蛋白診斷塵肺結(jié)核ROC曲線的曲線下面積(AUC)為0.801;γ-干擾素釋放試驗(yàn)靈敏度為86%,特異度為53%,YI為0.39,kappa值為0.39(P0.01),AUC=0.695;ASSURE TB Rapid靈敏度為48%,特異度為89%,YI為0.37,kappa值為0.37(P0.01),AUC=0.685;影像學(xué)空洞表現(xiàn)靈敏度為36%,特異度為98%,YI為0.34,kappa值為0.34(P0.01),AUC=0.670;影像學(xué)片狀表現(xiàn)靈敏度為73%,特異度為56%,YI為0.29,kappa值為0.29(P0.01),AUC=0.645;影像學(xué)團(tuán)塊表現(xiàn)靈敏度為30%,特異度為91%,YI為0.21,kappa值為0.21(P0.01),AUC=0.6052診斷效率最佳的組合模型為影像學(xué)空洞、團(tuán)塊、片狀并聯(lián)方案與實(shí)驗(yàn)室檢查C反應(yīng)蛋白、γ-干擾素釋放試驗(yàn)并聯(lián)方案進(jìn)行串聯(lián),結(jié)果顯示此法的靈敏度為92%,特異度為74%,約登指數(shù)(YI)為0.66,kappa值為0.66(P0.01),ROC曲線下面積(AUC)為0.825。結(jié)論1各診斷方法單獨(dú)使用的診斷效率從高到低排序?yàn)镃反應(yīng)蛋白、γ-干擾素釋放試驗(yàn)、ASSURE TB R apid、影像學(xué)空洞表現(xiàn)、影像學(xué)片狀表現(xiàn)、影像學(xué)團(tuán)塊表現(xiàn)。2診斷效率最佳的組合模型為影像學(xué)空洞、團(tuán)塊、片狀并聯(lián)方案與實(shí)驗(yàn)室檢查C反應(yīng)蛋白、γ-干擾素釋放試驗(yàn)并聯(lián)方案進(jìn)行串聯(lián)。
[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.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R135.2;R521

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊日芳,高先鳳;老年塵肺結(jié)核并慢性肺原性心臟病的觀察與護(hù)理[J];大同醫(yī)學(xué)專科學(xué)校學(xué)報(bào);2001年03期

2 張健;14例塵肺結(jié)核調(diào)查與分析[J];職業(yè)衛(wèi)生與病傷;2002年04期

3 孔冬青;塵肺結(jié)核并發(fā)持久的三度房室傳導(dǎo)阻滯1例[J];中國煤炭工業(yè)醫(yī)學(xué)雜志;2003年09期

4 張欣;張榮波;許禮發(fā);王永祥;;塵肺結(jié)核患者血清中某些免疫指標(biāo)的表達(dá)及意義[J];中國職業(yè)醫(yī)學(xué);2008年01期

5 王文舉;塵肺結(jié)核的臨床研究[J];日本醫(yī)學(xué)介紹;1987年08期

6 萬國順;對(duì)某市塵肺結(jié)核的流行病學(xué)分析[J];工業(yè)衛(wèi)生與職業(yè)病;1991年02期

7 郭平,張仲平;煤礦工人塵肺結(jié)核患者轉(zhuǎn)歸調(diào)查[J];中國工業(yè)醫(yī)學(xué)雜志;1992年02期

8 袁素潑;盧光玉;;塵肺結(jié)核臨床診斷的初步探討[J];貴州醫(yī)藥;1993年04期

9 孫曉紅,張方清;塵肺結(jié)核的防治與護(hù)理探析[J];邯鄲醫(yī)學(xué)高等�？茖W(xué)校學(xué)報(bào);1999年04期

10 甘傳偉,楊俊芝;802例塵肺結(jié)核病例的調(diào)查[J];中國工業(yè)醫(yī)學(xué)雜志;2000年05期

相關(guān)會(huì)議論文 前2條

1 王希霞;;老年塵肺結(jié)核并發(fā)慢性肺源性心臟病的觀察與護(hù)理[A];甘肅省中醫(yī)藥學(xué)會(huì)2010年會(huì)員代表大會(huì)暨學(xué)術(shù)年會(huì)論文匯編[C];2010年

2 彭娟娟;瞿菁;賈曉東;李朝偉;徐麗玲;汪森然;;塵肺結(jié)核生存年限與死亡危險(xiǎn)度分析[A];2008年全國職業(yè)性呼吸系統(tǒng)疾病學(xué)術(shù)研討會(huì)論文集[C];2008年

相關(guān)碩士學(xué)位論文 前5條

1 劉釗;影像學(xué)與實(shí)驗(yàn)室檢測(cè)指標(biāo)聯(lián)合診斷塵肺結(jié)核的價(jià)值分析[D];華北理工大學(xué);2016年

2 唐桂鈺;河北鋼鐵集團(tuán)接塵工人塵肺結(jié)核流行規(guī)律及其發(fā)病影響因素研究[D];河北聯(lián)合大學(xué);2011年

3 馬英華;山東省煤礦工人塵肺結(jié)核患病現(xiàn)狀分析及防治對(duì)策研究[D];濟(jì)南大學(xué);2015年

4 王曉秋;淮南礦區(qū)塵肺結(jié)核患者結(jié)核分枝桿菌L型感染及耐藥性研究[D];安徽理工大學(xué);2005年

5 陸軍;淮南礦區(qū)塵肺結(jié)核患者結(jié)核分枝桿菌L型相關(guān)耐藥基因突變研究[D];安徽理工大學(xué);2006年

，

本文編號(hào)：1357337