CAJ | 학술논문

目的以基于Logistic回归的受试者工作特征(ROC)曲线分析方法,评价VCA/IgA、EA/IgA、Rta/IgG和EBNA1/IgA等EB病毒抗体不同组合在鼻咽癌诊断中的价值.方法收集211例初治鼻咽癌和203例相似症状的非鼻咽癌病例的血清,采用免疫酶法检测VCA/IgA及EA/IgA,酶联免疫吸附法检测Rta/lgG和EBNA1/IgA.对各种的抗体组合建立Logistic回归模型,以预测概率为分析指标,应用ROC曲线分析,评价不同组合对鼻咽癌的诊断价值.结果单一指标评价,VCA/IgA敏感度最高(98.1%),EA/IgA特异度最高(98.5%).以基于Logistic同归的ROC曲线分析各项组合,敏感度和特异度均有所提高.双指标组合中,VCA/IgA+Rta/lgG组合的ROC曲线下面积(AUC)为0.991,诊断效能最高,敏感度、特异度及约登指数分别为94.8%、98.0%及0.928.VCA/IgA+Rta/IgG+EBNA1/IgA组合和4项指标组合的敏感度、特异度及约登指数分别为94.8%、98.5%、0.933和96.7%、97.0%、0.937;这两种多指标组合的AUC与VCA/IgA+Rta/IgG组合比较差异均无统计学意义(P＞0.05).结论基于Logistic回归的ROC曲线分析方法可以为多指标联合诊断试验提供更客观的综合分析,VCA/IgA和Rta/IgG联合检测具有互补作用,是鼻咽癌血清学诊断的合适组合.
목적 이기우Logistic회귀적수시자공작특정(ROC)곡선분석방법,평개VCA/IgA、EA/IgA、Rta/IgG화EBNA1/IgA등EB병독항체불동조합재비인암진단중적개치.방법 수집211례초치비인암화203례상사증상적비비인암병례적혈청,채용면역매법검측VCA/IgA급EA/IgA,매련면역흡부법검측Rta/lgG화EBNA1/IgA.대각충적항체조합건립Logistic회귀모형,이예측개솔위분석지표,응용ROC곡선분석,평개불동조합대비인암적진단개치.결과 단일지표평개,VCA/IgA민감도최고(98.1%),EA/IgA특이도최고(98.5%).이기우Logistic동귀적ROC곡선분석각항조합,민감도화특이도균유소제고.쌍지표조합중,VCA/IgA+Rta/lgG조합적ROC곡선하면적(AUC)위0.991,진단효능최고,민감도、특이도급약등지수분별위94.8%、98.0%급0.928.VCA/IgA+Rta/IgG+EBNA1/IgA조합화4항지표조합적민감도、특이도급약등지수분별위94.8%、98.5%、0.933화96.7%、97.0%、0.937;저량충다지표조합적AUC여VCA/IgA+Rta/IgG조합비교차이균무통계학의의(P＞0.05).결론 기우Logistic회귀적ROC곡선분석방법가이위다지표연합진단시험제공경객관적종합분석,VCA/IgA화Rta/IgG연합검측구유호보작용,시비인암혈청학진단적합괄조합.
Objective This study was aimed to investigate the diagnostic value of combined determination of Epstein-Barr virus (EBV) antibodies for nasopharyngeal carcinoma (NPC),including immunoglobulin (Ig) A against EBV capsid antigens (VCA),IgA against early antigens (EA),IgG against BRLF1 transcription activator (Rta) and IgA against EBV nuclear antigen-1 (EBNA1),assessed with receiver operating characteristic (ROC)curve based on logistic regression.MethodsSerum samples derived from 211 untreated patients with NPC and 203 non-NPC ENT patients were examined for the presence of VCA/IgA and EA/IgA by immunoenzymatic assay,Rta/IgG and EBNA1/IgA by enzyme-linked immnunosorbent assay (ELISA).The different Logistic regression models were established for various combined determinations of antibodies,respectively.Using the predicted probability as the analyzed variable,ROC curve was applied to evaluate the diagnostic accuracy of different combined determinations.Results The sensitivity of VCA/IgA (98.1% ) and the specificity of EA/IgA (98.5%) were the highest while detecting solely.The results which were analyzed by ROC curve based on Logistic regression showed that the sensitivity and specificity were improved.In two-marker combinations,VCA/IgA + Rta/IgG whose area under ROC curve (AUC) was 0.991 had the highest diagnostic accuracy,and its sensitivity,specificity and Youden index were 94.8%,98.0% and 0.928 respectively.No significant difference of AUC were found comparing VCA/IgA + Rta/IgG with VCA/IgA + Rta/IgG + EBNA1/IgA and four-marker combination( P ＞ 0.05),of which sensitivity,specificity and Youden index were 94.8%,98.5%,0.933 and 96.7%,97.0%,0.937,respectively.Conclusion The approach of ROC curve based on Logistic regression can improve synthetic efficiency for combined determination of multiple markers.The combined determination of VCA/IgA and Rta/IgG with a complementary effect is optimal for NPC serodiagnosis.