本文關(guān)鍵詞：影像學(xué)與實驗室檢測指標聯(lián)合診斷塵肺結(jié)核的價值分析　出處：《華北理工大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的通過對比分析塵肺結(jié)核組與塵肺非結(jié)核組影像學(xué)及實驗室檢測指標的差異,篩選塵肺結(jié)核的特征性指標,評價各指標獨立和聯(lián)合應(yīng)用時診斷塵肺結(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)。方法實驗室檢測由醫(yī)院檢驗科完成,研究生負責數(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)計軟件包進行統(tǒng)計學(xué)處理。單因素分析(即組間比較)采用t檢驗或卡方檢驗,多因素篩選采用Logistic回歸模型;計量資料進行相關(guān)回歸分析,計數(shù)資料進行一致性分析;計算篩選出的各指標的靈敏度、特異度、約登指數(shù)、kappa值,采用ROC曲線進行比較;根據(jù)指標獨立使用時的靈敏度和特異度,確定聯(lián)合試驗的類型(串聯(lián)試驗或并聯(lián)試驗);計算不同指標組合時的靈敏度、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、團塊、片狀并聯(lián)方案與實驗室檢查C反應(yīng)蛋白、γ-干擾素釋放試驗并聯(lián)方案進行串聯(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各診斷方法單獨使用的診斷效率從高到低排序為C反應(yīng)蛋白、γ-干擾素釋放試驗、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)團塊表現(xiàn)。2診斷效率最佳的組合模型為影像學(xué)空洞、團塊、片狀并聯(lián)方案與實驗室檢查C反應(yīng)蛋白、γ-干擾素釋放試驗并聯(lián)方案進行串聯(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)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R135.2;R521

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