Mossman D, Somoza E
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.
Biol Psychiatry. 1989 Jan 15;25(2):159-73. doi: 10.1016/0006-3223(89)90160-1.
This article demonstrates methods by which receiver operating characteristics (ROC) analysis may be used to evaluate and improve the Dexamethasone Suppression Test (DST). ROC indices provide a description of nonbinary diagnostic tests that is independent of any particular cutoff and that allows investigators to use rigorous mathematical methods for selecting cutoffs and assessing overall performance. In this study, ROC analyses of previously published data suggest that (1) the accuracy of the DST might be improved by using a 0.5-mg oral steroid dose; (2) incorporation of dexamethasone serum levels does not improve the performance of the DST; and (3) the serum cortisol level used to define "no suppression" (or DST "positivity") should be varied to take into account diagnostic alternatives, prior probability of affective disorder, and the clinical goal for performing the test (e.g., maximizing utility, increasing information).
本文展示了一些方法，通过这些方法，受试者工作特征（ROC）分析可用于评估和改进地塞米松抑制试验（DST）。ROC指标提供了对非二元诊断测试的描述，该描述独立于任何特定的临界值，并且允许研究人员使用严格的数学方法来选择临界值并评估整体性能。在本研究中，对先前发表数据的ROC分析表明：（1）使用0.5毫克口服类固醇剂量可能会提高DST的准确性；（2）纳入地塞米松血清水平并不能改善DST的性能；（3）用于定义“无抑制”（或DST“阳性”）的血清皮质醇水平应有所变化，以考虑诊断替代方案、情感障碍的先验概率以及进行该测试的临床目标（例如，最大化效用、增加信息）。
