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目的评价血清皮质醇用于鉴别亚健康状态的价值。方法以首都医科大学附属宣武医院体检中心的体检人群作为研究对象,进行问卷调查,采集静脉血检测血清皮质醇和儿茶酚胺,以潜类别数为2拟合潜在分类模型,利用EM算法对潜类别概率和潜类别下各指标的条件概率进行估计,计算各指标的灵敏度与特异度并确定判断界值。结果模型的CAIC为67.02,AIC为28.14,这2个指标都比较小,说明模型拟合较好。3个评价指标中,血清皮质醇的诊断价值最高,灵敏度与特异度分别为0.778 1(95%:0.747 4~0.808 8)与0.964 4(95%CI:0.950 7~0.978 1),判定的界值为179 ng/m L。亚健康问卷的灵敏度与特异度分别为0.7363(95%CI:0.703 7~0.768 9)和0.701 7(95%CI:0.667 9~0.735 5),判定的界值为25分。血清儿茶酚胺灵敏度和特异度分别为0.602 5(95%CI:0.566 3~0.638 7)和0.522 3(95%CI:0.485 3~0.559 3)。结论血清皮质醇是用于判定亚健康状态的一个较好的指标,而亚健康调查问卷更适合用于亚健康人群的筛查。
Objective To evaluate the value of serum cortisol for identifying sub-health status. Methods Taking the physical examination population of Xuanwu Hospital Medical Center of Capital Medical University as the research object, the questionnaires were collected. The serum cortisol and catecholamines were collected by venous blood test. The potential classification model was fitted by 2 latent subgroups. Under the latent class, the conditional probability of each index is estimated, the sensitivity and specificity of each index are calculated, and the judgment threshold is determined. Results The CAIC of the model was 67.02 and the AIC was 28.14, both of which were relatively small, indicating that the model fitted well. Among the three evaluation indexes, the diagnostic value of serum cortisol was the highest, the sensitivity and specificity were 0.778 1 (95%: 0.747 4-0.808 8) and 0.964 4 (95% CI 0.950 7-0.978 1) The value is 179 ng / m L. The sensitivity and specificity of the sub-health questionnaire were 0.7363 (95% CI: 0.703 7-0.768 9) and 0.701 7 (95% CI 0.667 9-0.735 5 respectively), with a cut-off point of 25 points. Serum catecholamine sensitivity and specificity were 0.602 5 (95% CI: 0.566 3-0.638 7) and 0.522 3 (95% CI 0.485 3-0.559 3), respectively. Conclusion Serum cortisol is a better indicator of sub-health status, while sub-health questionnaire is more suitable for sub-health screening.