摘要
目的建立胰腺肿块良恶性鉴别诊断的评分系统,并评价其诊断效能。方法回顾分析2008年11月至2013年5月在长海医院普通外科诊治并经病理确诊的胰腺肿块性病变患者的病例资料,采用多重logistic回归分析方法建立胰腺肿块良恶性诊断的预测模型。基于模型中各变量的回归系数(β值)建立胰腺良恶性肿块鉴别诊断的评分系统,并进行外部人群验证。通过模型的一致性、区分能力和准确度评价评分系统的鉴别诊断效能。结果共纳入1 000例合格研究对象,建立的评分系统由年龄、纳差、糖尿病史、CA19-9 4个变量组成,分值范围为0~14分,其预测的一致性较好(P=0.13)。受试者工作特征(ROC)曲线下面积(95%CI)为0.82(0.79,0.86)(P<0.001),说明该评分系统区分度较好。以2分作为诊断界值,其敏感度、特异度、准确率、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为81.46%、66.88%、77.86%、88.26%、54.12%、2.46、0.28。胰腺恶性肿块在高风险人群(>2分)中的比例明显高于低风险人群(≤2分)中的比例(88.26%vs45.88%,P<0.001)。该评分系统的外部人群验证结果显示,ROC曲线下面积(95%CI)为0.81(0.76,0.86)(P<0.001),说明该预测模型的区分度较好,同时一致性也较好(P=0.716)。结论胰腺良恶性肿块临床诊断的预测模型及其评分系统能够较好地对该类患者进行良恶性风险分层,可以为胰腺肿块良恶性的临床鉴别诊断提供初步依据。
Objective To develop a scoring system for differential diagnosis of benign and malignant pancreatic lesions and to evaluate its diagnostic efficiency. Methods We retrospectively analyzed the medical records of patients with pancreatic lesions （with pathologically confirmed diagnosis） . the patients were treated in Changhai Hospital from November 2008 to May 2013. A differential diagnosis model was created using multiple logistic regression analysis. A scoring system for differential diagnosis of benign and malignant pancreatic lesions was established based on each regression coefficient, and then was externally validated. The differential diagnosis efficiency of the scoring system was assessed by its consistency, differential ability and accuracy. Results A total of 1 000 eligible participants were included in our research. The scoring system, which was scored from 0 to 14 points, comprised 4 variables： age, anorexia, diabetes history and serum CA19-9. The system had good consistency （P=0.13）, a good differential ability （area under the receiver operating characteristic [ROC] curve~ 0.82,95 % confidence interval [CI]： 0. 79-0. 86, P^0. 001）. When score 2 was used as the predictive cut-off value, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 81.46%, 66.88%, 77. 86%, 88. 26%, 54. 12%, 2. 46, and 0. 28, respectively. The risk （88. 260/00） of malignant pancreatic lesions in patients with high-risk scoresC〉2） was significantly higher than that （45.88 %） in patients with low-scores （≤2） （P〈0. 001）. External validation results showed the scoring system had good differential ability （area under the ROC curve=0.81,95%CI= 0. 76-0. 86,P〈0. 001） and consistency （P=0. 716）. Conclusion The prediction model and its scoring system is of great value for risk stratification of benign and malignant pancreatic lesions, which may be serve as an initial evidence for differential diagnosis of pancreatic lesions.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2014年第6期637-643,共7页
Academic Journal of Second Military Medical University
关键词
胰腺肿瘤
鉴别诊断
预测模型
评分系统
危险分层
pancreatic neoplasms
differential diagnosis
prediction model
scoring system
risk stratification
