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铅中毒筛选指标的再评价 |
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tecting those with blood lead ≥1.93 μmol/L and ≥2.90 μmol/L was calculated and compared. Results For detecting those with blood lead level ≥1.93 μmol/L, the area under ROC curve (AUCROC) of above indicators was 0.978 for ZPP, 0.973 for red cell P5'N, 0.937 for FEP, 0.890 for urine δ-ALA (significantly different from that for ZPP with P<0.05), and 0.845 for urine lead level (significantly different from that for ZPP with P<0.05), respectively. For detecting those with blood lead level ≥2.90 μmol/L，the area under ROC curve (AUCROC) of above indicators was 0.975 for red cell P5′N, 0.954 for ZPP, 0.906 for FEP (significantly different from that for red cell P5′N with P<0.05), 0.900 for urine δ-ALA (significantly different from that for red cell P5′N with P<0.05), and 0.750 for urine lead level (significantly different from that for red cell P5′N with P<0.05). Sensitivity of screening in parallel with ZPP and P5′N was significantly higher than that with urine levels of lead and δ-ALA. Conclusion Determinations of red cell P5′N and ZPP for detecting those with blood lead ≥1.93 μmol/L and ≥2.90 μmol/L are more accurate.
Key words Lead poisoning Diagnosis
随着铅中毒防治工作的开展，严重铅中毒已较少见，因此需对原有铅中毒指标作一新的评价，并寻找新的指标以提高筛选早期铅中毒病人的准确性。国内外过去对铅中毒大多采用敏感度和特异度这两个实验室指标。当诊断试验的结果为定性数据时，敏感度和特异度是评价诊断试验准确性的较好指标；但当诊断试验的结果是连续性的定量数据时，敏感度和特异度只能反映某一临界点的诊断试验准确性，而不能反映诊断试验其余临界点的准确性。受试者工作特征（ROC）曲线是将诊断试验的结果划分为若干个临界点，以每个临界点对应的真阳性率(即敏感度)为纵坐标，假阳性率(即1-特异度)为横坐标作图得出的曲线。ROC曲线下的面积(AUCROC)综合了诊断试验许多临界点的敏感度和特异度，全面反映诊断试验的准确性［1］。本研究用AUCROC对铅中毒筛选指标作一新的评价。
对象与方法
1.对象：从铅污染较严重的蓄电池厂选取157名职业性铅接触工人，近期连续性接触铅超过1年。血铅：＜1.93 μmol/L者94人，≥1.93～2.90 μmol/L者32人，≥2.90 μmol/L者31人。
2．检测方法：血铅：无焰原子吸收光谱法。尿铅：热消化-双硫腙比色法。锌卟啉（ZPP）:国产ZPP测定仪。红细胞游离原卟啉（FEP）:乙酸乙酯-乙酸萃取法，荧光分光光度法。尿δ-氨基-酮戊酸（δ-ALA）：乙酸乙酯萃取法。红细胞嘧啶5′核苷酸酶（P5′N）：Valentine比色法。
3．资料分析：
（1）用ROC上一页 [1] [2] [3] 下一页
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