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| 胰腺肿块良恶性鉴别诊断评分系统的建立与验证 |
| 杨鸣1,2△,张晓兰1△,钱维2,杨帆1,2,蔡晔1,朱伟2,张永镇1,2,李兆申1,2*,蔡全才2* |
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(1. 第二军医大学长海医院消化内科, 上海 200433;
2. 第二军医大学临床流行病学与循证医学中心, 上海 200433
△共同第一作者
*通信作者) |
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| 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% vs 45.88%，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。 |
| 关键词: 胰腺肿瘤 鉴别诊断 预测模型 评分系统 危险分层 |
| DOI：10.3724/SP.J.1008.2014.00637 |
| 投稿时间：2014-02-28修订日期：2014-05-18 |
| 基金项目: |
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| A scoring system for differential diagnosis of benign and malignant pancreatic lesions：establishment and validation |
| YANG Ming1,2△,ZHANG Xiao-lan1△,QIAN Wei2,YANG Fan1,2,CAI Ye1,ZHU Wei2,ZHANG Yong-zhen1,2,LI Zhao-shen1,2*,CAI Quan-cai2* |
(1. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Center of Clinical Epidemiology and Evidence Based Medicine, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding authors.) |
| Abstract: |
| 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 (88.26%) of malignant pancreatic lesions in patients with high-risk scores(>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. |
| Key words: pancreatic neoplasms differential diagnosis prediction model scoring system risk stratification |
