Logistic回归和ROC工作曲线评价联合检测血清CA153,TPS,CYFRA21-1在乳腺癌诊断中的临床价值
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摘要
目的通过Logistic回归和ROC工作曲线综合分析糖链抗原153(CA153)、组织多肽特异抗原(TPS)、细胞角质蛋白19片段(cytokeratin 19fragment antigen 21-1,CYFRA21-1)联合检测在乳腺癌诊断中的临床价值。方法采用罗氏全自动电化学发光仪检测50例乳腺癌患者(乳腺癌组)、30例健康者(对照组)血清CA153,TPS和CYFRA21-1水平,分析比较乳腺癌组与对照组三项指标水平的差异,两组三项指标单项及联合检测阳性率比较;两组血清CA153,TPS,CYFRA21-1单项与联合检测对乳腺癌诊断试验的评价指标比较;通过Logistic回归建立回归模型,用ROC工作曲线分析CA153,TPS和CYFRA21-1对乳腺癌的诊断价值。结果(1)乳腺癌组患者血清CA153,TPS和CYFRA21-1水平较对照组明显升高,差异具有统计学意义(t=3.30,P=0.001;t=2.78,P=0.007;t=4.31,P=0.000 05);(2)单项检测的阳性率从高到低依为:CYFRA21-1(60.0%)>TPS(54.0%)>CA153(50.0%),CA153+TPS+CYFRA21-1的阳性率为70.0%,比单项检测显著升高;(3)单项检测中CYFRA21-1的敏感度较高,CA153的特异度较高,单项检测与三项联合检测比较敏感度由50.0%升高到70.0%,符合率由67.5%升高到77.5%,阴性预测值由53.7%升高到64.3%,特异度、阳性预测值略有下降;(4)通过Logistic回归得乳腺癌的概率预测回归模型Y=1/[1+EXP(0.099 X1+0.038 X2+0.578 X3-9.694)],三项联合检测的ROC曲线下面积明显大于CA153,TPS,CYFRA21-1单独检测的ROC曲线下面积。结论联合检测血清CA153,TPS,CYFRA21-1在乳腺癌早期诊断中具有重要的临床价值。
Objective To analyse comprehensively Clinical Value of Logistic regression and ROC curve of detection combined with serum carbohydrate antigen(CA)153,tissue polypeptide specific antigen(TPS)and cell keratin segments of 19(CYFRA21-1)for diagnosis of breast cancer.Methods Used Roche Automatic Electrochemical Luminescence Instrument to detect serum CA153,TPS and CYFRA21-1 level of 50 patients with breast cancer(breast cancer group)and 30 cases of healthy subjects(control group).Analysed and compared serum CA153,TPS and CYFRA21-1 level difference of breast cancer group and control group,and single and joint detection of serum CA153,TPS and CYFRA21-1.The diagnosis performance of breast cancer(sensitivity,specificity,coincidence rate,positive predictive value and negative predictive value)was compared between the two groups of serum CA153,TPS and CYFRA21-1.The regression model was established by Logistic regression,and ROC curve analyzes CA153,TPS and CYFRA21-1 value to the diagnosis of breast cancer.Results(1)In the breast cancer group the serum CA153,TPS and CYFRA21-1 levels werehigher than those in the control group,and the difference was statistically significant(P<0.05).(2)The positive rate of single test was from high to low:CYFRA21-1(60.0%)>TPS(54.0%)>CA153(50.0%),CA153+TPS+CYFRA21-1 with a positive rate of 70.0%,significantly higher than that of single-item detection.(3)CYFRA21-1 in single detection sensitivity was higher,CA153 specific degrees higher,single detection compared with three joint detection sensitivity increased from 50.0%to 70.0%,the coincidence rate increased from 67.5%to 77.5%,negative predictive value increased from 53.7%to 64.3%,specific degree,positive predictive value fell slightly.(4)The regression model Y=1/[1+EXP(0.099 X1+0.038 X2+0.578 X3-9.694)],the area under the ROC curve of the three joint tests was significantly larger than that of the ROC curve of CA153,TPS and CYFRA21-1 separately.Conclusion The combined detection of CA153,TPS and CYFRA21-1 has important clinical value in early diagnosis of breast cancer.
Objective To analyse comprehensively Clinical Value of Logistic regression and ROC curve of detection combined with serum carbohydrate antigen(CA)153,tissue polypeptide specific antigen(TPS)and cell keratin segments of 19(CYFRA21-1)for diagnosis of breast cancer.Methods Used Roche Automatic Electrochemical Luminescence Instrument to detect serum CA153,TPS and CYFRA21-1 level of 50 patients with breast cancer(breast cancer group)and 30 cases of healthy subjects(control group).Analysed and compared serum CA153,TPS and CYFRA21-1 level difference of breast cancer group and control group,and single and joint detection of serum CA153,TPS and CYFRA21-1.The diagnosis performance of breast cancer(sensitivity,specificity,coincidence rate,positive predictive value and negative predictive value)was compared between the two groups of serum CA153,TPS and CYFRA21-1.The regression model was established by Logistic regression,and ROC curve analyzes CA153,TPS and CYFRA21-1 value to the diagnosis of breast cancer.Results(1)In the breast cancer group the serum CA153,TPS and CYFRA21-1 levels werehigher than those in the control group,and the difference was statistically significant(P<0.05).(2)The positive rate of single test was from high to low:CYFRA21-1(60.0%)>TPS(54.0%)>CA153(50.0%),CA153+TPS+CYFRA21-1 with a positive rate of 70.0%,significantly higher than that of single-item detection.(3)CYFRA21-1 in single detection sensitivity was higher,CA153 specific degrees higher,single detection compared with three joint detection sensitivity increased from 50.0%to 70.0%,the coincidence rate increased from 67.5%to 77.5%,negative predictive value increased from 53.7%to 64.3%,specific degree,positive predictive value fell slightly.(4)The regression model Y=1/[1+EXP(0.099 X1+0.038 X2+0.578 X3-9.694)],the area under the ROC curve of the three joint tests was significantly larger than that of the ROC curve of CA153,TPS and CYFRA21-1 separately.Conclusion The combined detection of CA153,TPS and CYFRA21-1 has important clinical value in early diagnosis of breast cancer.
引文
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[8]岳璇弟,褚旭.乳腺癌患者血清多项指标与复发转移的相关性研究[J].海南医学院学报,2014,20(8):1120-1122.Yue XD,Chu X.Correction between serum VEGF,PRL,HER2,TPS,SCDAOL,MVD and recurrence,metastasis of patients with breast cancer[J].Journal of Hainan Medical University,2014,20(8):1120-1122.
[9]蒋显勇,易艳军,梁庄严,等.血清HER-2/neu,TPS,CA15-3和TSGF联合检测在乳腺癌诊断中的价值[J].实用医学杂志,2016,32(24):4115-4117.Jiang XY,Yi YJ,Liang ZY,et al.The clinical value of combined detection of HER-2/neu,TPS,CA15-3and TSGF in the diagnosis of breast cancer[J].The Journal of Practical Medicine,2016,32(24):4115-4117.
[10]何翠兰,李才元,刘翠燕,等.糖尿病伴乳腺癌患者细胞角蛋白19片段抗原21-1水平的变化及其临床意义[J].中国糖尿病杂志,2017,25(3):250-254.He CL,Li CY,Liu CY,et al.Changes and clinical significa of CYFRA21-1in diabetic patients with breast cancer[J].Chinese Journal of Diabetes,2017,25(3):250-254.
[11]黄国福,冷晓玲.血清CYFRA21-1,CA125及CA72-4对食管癌的诊断价值[J].标记免疫分析与临床,2014,21(3):229-231.Huang GF,Leng XL.Diagnosis value of serum CYFRA 21-1,CA125and CA72-4in esophageal carcer[J].Labeled Immunoassays and Clinical Medicine,2014,21(3):229-231.
[12]郝艳萍,吴俊,艾风波.CA19-9,CA125,CEA和CYFRA21-1检测对肺腺癌患者骨转移的诊断价值分析[J].标记免疫分析与临床,2016,23(12):1372-1374,1398.Hao YP,Wu J,Ai FB.Ca19-9,CA125,CEA and CYFRA 21-1detection in the diagnosis of bone metastasis in patients with lung cancer[J].Labeled Immunoassays and Clinical Medicine,2016,23(12):1372-1374,1398.
[13]李凤巧.PSA,CYFRA 21-1,CA153,CEA的联合检测在乳腺癌中的临床价值[J].医学理论与实践,2013,26(2):156-157.Li FQ.The value of combined measurement of PSA,CYFRA 21-1,CA153and CEA used in breast cancinoma[J].The Journal of Medical Theory and Practice,2013,26(2):156-157.
[14]张晓洁,张美娟,张立涛,等.CEA,CA153,CYFRA21-1,CRP联合检测在乳腺癌辅助诊断中的临床价值探讨[J].国际检验医学杂志,2017,38(23):3352-3354.Zhang XJ,Zhang MJ,Zhang LT,et al.The clinical value of CEA,CA153,CYFRA 21-1 and CRP in breast cancer assisted diagnosis[J].International Journal of Laboratory Medicine,2017,38(23):3352-3354.
[15]陈佳,向玲亚,邵华侨,等.运用Logistic回归和ROC曲线综合评价肿瘤标志物对肺癌的诊断价值[J].检验医学与临床,2017,14(5):604-606.Chen J,Xiang LY,Shao HQ,et al.Comprehensive evaluation on diagnostic value of serum tumor markers in lung cancer by using logistic regression and ROC curve[J].Laboratory Medicine and Clinic,2017,14(5):604-606.
[16]赵海娜,彭玉兰,骆洪浩,等.乳腺影像报告数据系统超声图像特征预测乳腺癌风险的logistic模型及诊断效能研究[J].华西医学,2015,30(12):2249-2253.Zhao HN,Peng YL,Luo HH,et al.A logistic regression model based on breast imaging report and data system lexicon to predict the risk of malignancy[J].West China Medical Journal,2015,30(12):2249-2253.
[17]胡道军,郁淼,张洪磊,等.基于Logistic回归和ROC曲线综合评价IMA,NLR,hs-CRP和CK-MB联合检测对早期急性心肌梗死的诊断价值[J].现代检验医学杂志,2016,31(5):76-80.Hu DJ,Yu M,Zhang HL,et al.Comprehensive evaluation of the diagnostic value of the combined detection of IMA,NLR,hs-CRP and CK-MB for acute myocardial infarction based on ROC curve and lagistic regression analysis[J].Journal of Modern Laboratory Medicine,2016,31(5):76-80.
[2]薛永飞,任中海,沈艳丽.癌相关抗原153、癌胚抗原、p53抗体及组织多肽特异性抗原在老年乳腺癌患者血清中的表达及其临床意义[J].中国老年学杂志,2014,34(3):806-807.Xue YF,Ren ZH,Shen YL.The expression and clinical significance of cancer-related antigen 153,cancer embryo antigen,p53antibody and tissue polypeptide specific antigen in the serum of elderly patients with breast cancer[J].Chinese Journal of Gerontology,2014,34(3):806-807.
[3]皮亚平,田柳.肿瘤标记物CA153,CA125联合检查对乳腺癌诊断的价值分析[J].实用癌症杂志,2017,32(8):1351-1353.Pi YP,Tian L.Value of combined examination of tumor marker CA153and CA125in the diagnosis of breast cancer[J].The Practical Journal of Cancer,2017,32(8):1351-1353.
[4]董娜,胡黎明.CEA,CA153和CRP对乳腺癌的诊断价值研究[J].河南医学研究,2017,26(20):3668-3670.Dong N,Hu LM.Diagnostic value of CEA,CA153and CRP in breast cancer[J].Henan Medical Research,2017,26(20):3668-3670.
[5]南永刚,许建林,李楠,等.CA153,CA125联合HER-2检测在乳腺癌各临床分期诊断中的应用[J].现代肿瘤医学,2016,24(19):3070-3073.Nan YG,Xu JL,Li N,et al.The role of CA153,CA125,HER-2combined detection for the diagnosis of breast cancer[J].Journal of Modern Oncology,2016,24(19):3070-3073.
[6]谢小梅,苏荣,吴英,等.乳腺癌患者血清PSA,CYFRA21-1,CA153,CEA水平变化及临床应用价值探讨[J].黑龙江医药,2017,30(6):1216-1218.Xie XM,Su R,Wu Y,et al.Breast cancer patients serum PSA,CYFRA21-1,CA153and CEA level change and the clinical application value[J].Heilongjiang Medicine Journal,2017,30(6):1216-1218.
[7]郑平燕.外周血CEA,CA153,CA125在乳腺癌临床筛查中的应用[J].中国妇幼保健,2015,6(16):2520-2522.Zheng PY.Peripheral blood CEA,CA153,CA125application in clinical screening for breast cancer[J].Maternal and Child Health Care of China,2015,6(16):2520-2522.
[8]岳璇弟,褚旭.乳腺癌患者血清多项指标与复发转移的相关性研究[J].海南医学院学报,2014,20(8):1120-1122.Yue XD,Chu X.Correction between serum VEGF,PRL,HER2,TPS,SCDAOL,MVD and recurrence,metastasis of patients with breast cancer[J].Journal of Hainan Medical University,2014,20(8):1120-1122.
[9]蒋显勇,易艳军,梁庄严,等.血清HER-2/neu,TPS,CA15-3和TSGF联合检测在乳腺癌诊断中的价值[J].实用医学杂志,2016,32(24):4115-4117.Jiang XY,Yi YJ,Liang ZY,et al.The clinical value of combined detection of HER-2/neu,TPS,CA15-3and TSGF in the diagnosis of breast cancer[J].The Journal of Practical Medicine,2016,32(24):4115-4117.
[10]何翠兰,李才元,刘翠燕,等.糖尿病伴乳腺癌患者细胞角蛋白19片段抗原21-1水平的变化及其临床意义[J].中国糖尿病杂志,2017,25(3):250-254.He CL,Li CY,Liu CY,et al.Changes and clinical significa of CYFRA21-1in diabetic patients with breast cancer[J].Chinese Journal of Diabetes,2017,25(3):250-254.
[11]黄国福,冷晓玲.血清CYFRA21-1,CA125及CA72-4对食管癌的诊断价值[J].标记免疫分析与临床,2014,21(3):229-231.Huang GF,Leng XL.Diagnosis value of serum CYFRA 21-1,CA125and CA72-4in esophageal carcer[J].Labeled Immunoassays and Clinical Medicine,2014,21(3):229-231.
[12]郝艳萍,吴俊,艾风波.CA19-9,CA125,CEA和CYFRA21-1检测对肺腺癌患者骨转移的诊断价值分析[J].标记免疫分析与临床,2016,23(12):1372-1374,1398.Hao YP,Wu J,Ai FB.Ca19-9,CA125,CEA and CYFRA 21-1detection in the diagnosis of bone metastasis in patients with lung cancer[J].Labeled Immunoassays and Clinical Medicine,2016,23(12):1372-1374,1398.
[13]李凤巧.PSA,CYFRA 21-1,CA153,CEA的联合检测在乳腺癌中的临床价值[J].医学理论与实践,2013,26(2):156-157.Li FQ.The value of combined measurement of PSA,CYFRA 21-1,CA153and CEA used in breast cancinoma[J].The Journal of Medical Theory and Practice,2013,26(2):156-157.
[14]张晓洁,张美娟,张立涛,等.CEA,CA153,CYFRA21-1,CRP联合检测在乳腺癌辅助诊断中的临床价值探讨[J].国际检验医学杂志,2017,38(23):3352-3354.Zhang XJ,Zhang MJ,Zhang LT,et al.The clinical value of CEA,CA153,CYFRA 21-1 and CRP in breast cancer assisted diagnosis[J].International Journal of Laboratory Medicine,2017,38(23):3352-3354.
[15]陈佳,向玲亚,邵华侨,等.运用Logistic回归和ROC曲线综合评价肿瘤标志物对肺癌的诊断价值[J].检验医学与临床,2017,14(5):604-606.Chen J,Xiang LY,Shao HQ,et al.Comprehensive evaluation on diagnostic value of serum tumor markers in lung cancer by using logistic regression and ROC curve[J].Laboratory Medicine and Clinic,2017,14(5):604-606.
[16]赵海娜,彭玉兰,骆洪浩,等.乳腺影像报告数据系统超声图像特征预测乳腺癌风险的logistic模型及诊断效能研究[J].华西医学,2015,30(12):2249-2253.Zhao HN,Peng YL,Luo HH,et al.A logistic regression model based on breast imaging report and data system lexicon to predict the risk of malignancy[J].West China Medical Journal,2015,30(12):2249-2253.
[17]胡道军,郁淼,张洪磊,等.基于Logistic回归和ROC曲线综合评价IMA,NLR,hs-CRP和CK-MB联合检测对早期急性心肌梗死的诊断价值[J].现代检验医学杂志,2016,31(5):76-80.Hu DJ,Yu M,Zhang HL,et al.Comprehensive evaluation of the diagnostic value of the combined detection of IMA,NLR,hs-CRP and CK-MB for acute myocardial infarction based on ROC curve and lagistic regression analysis[J].Journal of Modern Laboratory Medicine,2016,31(5):76-80.