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1()(diagnostictest),()()()(goldstandard)(+D-D)(+T-T)13-1(TP)(,TN)(,FN)(,FP)22×DT+D-D())+T-T(Bayes)2)()|()()|()()|()|(--++++++++++=DPDTPDPDTPDPDTPTDP(13-1))(+DP(priorprobability))(1)(+--=DPDP)|(++DTP)|(-+DTP(1))|(++TDP(posteriorprobability)13-120001(electrocardiogramECG)98ECG1ECGECG)(+DP0005.020001==98.0%98)|(==++DTP01.0%1)|(==-+DTP9995.00005.01)(1)(=-=-=+-DPDP(13-1)0467.09995.001.00005.098.00005.098.0)|(=×+××=++TDP4.67ECG(ECG)ECG)(+DP)|(++TDP)(+DP100.1)|(++TDP91.59ECGBayes∑=miiiniimmnmmnmAPABPABPABPAPABPABPABPBBBAP)()|()|()|()()|()|()|()|(212121LLL(13-2)mi,,2,1L=13-1A-D+DB-T+T(13-1)B+T313-2ECG700520180(13-2)ECG13-2ECGECG416(TP)9(FP)425104(FN)171(TN)275520180700(N)Youden%100×+=NTNTP3/))(NFNFPTNTPSE++=%86.838386.0%100700171416==×+==SE%../))(3910139070010491714163==++5%95%(cut-offpoint)(13-1)(sensitivitySen)(truepositiverateTPR)TPRFNTPTPDTPSen=+==++)()|((13-3)4)()1()(3FNTPSenSenFNTPFNTPSEsen+-=+×=Sen416/5200.8,TPR0.880%ECG%75.10175.0520/)8.01(8.0==-=senSE(specificitySpe))()|(TNFPTNDTPSpe+==--(13-4))/()1()(3TNFPSpeSpeTNFPTNFPSEspe+-=+×=Spe171/180=0.95,95%%62.10162.0180/)95.01(95.0==-=speSE(13-3))(1FNTPFNSen+=-=β(13-4))(1TNFPFPSpe+=-=α(falsepositiverateFPR)=-=Sen1b10.8=0.205.095.011=-=-=SpeaFPR=0.0513-1513-1(0,1)1YoudenYoudenYouden(Youden’sindex,J)FPRTPRSpeSenJ-=-+=1(13-5))/()1()/()1()()(33TNFPSpeSpeFNTPSenSenTNFPTNFPFNTPFNTPSEJ+-++-=+×++×=75.005.08.0=-=JYouden0.750239.0180)95.01(95.0520)8.01(8.0=-+-=JSEYouden(-1,+1)+1(positivelikelihoodratio+LR)6)1(SpeSenFPRTPRLR-==+(13-6)1605.08.0==+LR16+LR(0,)+LR(negativelikelihoodratio-LR)SpeSenFPRTPRLR)1()1()1(-=--=-(13-7)2105.095.0)8.01(=-=-LR0.2105-LR(0,)(positivepredictivevalue+PV))()|()()|()()|()|(--+++++++++++==DPDTPDPDTPDPDTPTDPPV⎟⎟⎠⎞⎜⎜⎝⎛--+=--+=00000)1)(1(11)1)(1(SenPPSpePSpeSenPSenP(13-8))(0+=DPP)(1)(+--=DPDP01P-=SenSpe)1)(1(0PSpe--0SenPSen=0.8Spe=0.95=0P0.0005(13-7)12610079.00005.08.0)0005.01)(95.01(11≈=⎟⎠⎞⎜⎝⎛×--+=+PVECG12617ECG=0P0.2%12.949412.0==+PV(negativepredictivevalue-PV)(13-2)A-D+DB-T)()|()()|()()|()|(++----------+==DPDTPDPDTPDPDTPTDPPV⎟⎟⎠⎞⎜⎜⎝⎛--+=-+--=)1()1(11)1()1()1(00000PSpePSenPSenPSpePSpe(13-9)=0P0.0005Sen=0.8Spe=0.95(13-9)9999.0)0005.01(95.00005.0)8.01(11=⎟⎟⎠⎞⎜⎜⎝⎛-××-+=-PV1000099991ECG=0P0.2%9595.0==-PVNFNTPP)(1+=)(0+=DPP(13-8))(FPTPTPPV+=+(13-10)(13-9))(TNFNTNPV+=-(13-11)(13-10)(13-11)+PV416/4250.9788-PV171/2750.6218(13-8)(13-9)=+=NFNTPP)(17429.0700)104416(=+=0P0.0005NFNTPP)(1+=)(0+=DPP(13-10)(13-11)13-28+PV-PV(0,1)1ROCYouden()()(TPR)(FPR)()TPRFPR(receiveroperatingcharacteristic)(relativeoperatingcharacteristic)ROC(ROCcurve)ROCTPRFPRFPRTPRROCROCROCROC13-35413-3TPRFPR()13-316.513.512.811.25.08.56.44.61.798(1.7)89(FPR,TPR)ROC(13-4)13-413-3FPRTPR16.513.512.811.28.56.45.04.6FPR00001/42/42/43/4TPR1/52/53/54/54/54/55/55/513-4109CT5158CT1234513-5TPRFPR13-5109CT1234532211335133661125854()4ROC13-613-613-5FPRTPR()5432FPR0.03450.22410.32960.4310TPR0.64710.86270.90200.941210ROCFPR(1)TPR()ROCROCROC(0,0)(1,1)011013-5ROC13-213-2ROCTPR=FPR(chanceline)ROCROCROCROC(ZA)0.51,ZA=0.5ZA=1ZA0.5~0.70.7~0.90.9(Swets,1988)ZAHanleyMcNeilDelong,DelongClarke-Pearson()HanleyMcNeilcnjX(j=1,2,,cn)aniX(i=1,2,,an)WilcoxonMann-WhitneyROC(ZA)11),(111jinjnicaZXXnnAca∑∑==ψ=(13-12)jijijijiXXXXXXXX=⎪⎩⎪⎨⎧=ψ05.01),(aniXcnjX10.50ancnZAZAcaZcZaZZZnnAQnAQnAAASE))(1())(1()1()(2221--+--+-=(13-13))(ZASEZA1Q2QROCZA=0.5)(5.0ZZASEAZ-=ZAαu)(ZASEZA100(1)%1ZA2ZA1SE2SE222121||SESEAAZZZ+-=(13-14)ROC(HanleyandMcNeil,1982;1983)()(decisiontree)1213-313-3(A)(B1)(B2)(B3)(C1)(C2)(C4)(C3)(C5)(C6)C4C6Pi(14,,2,1L=i)(utility)10.709080p1p4p21p1p31p4p530p61p57013-3(expectedbenefit)C1965.0002.07.005.0193.0=×+×+×B1B2B3c1c2c3c5c6c4p1=0.90,,p2=0.10,p3=0.20p4=0.80,p5=0.30p6=0.70,,P11=0.10P9=0.20P8=0.70P7=0.10P6=0.01P5=0.02P4=0.97P3=0.02P2=0.05P1=0.93P10=1.00P14=1.00P13=0.20P12=0.70X6=0X13=0X12=0.7X9=0X8=0.7X14=1X11=1X10=1X7=1X5=0.7X4=1X3=0X2=0.7X1=113C2984.0001.07.002.0197.0=×+×+×C3590.0020.07.070.0110.0=×+×+×C400.1100.1=×C5590.0020.07.070.0110.0=×+×+×C600.1100.1=×B197.09669.0985.010.0965.090.0==×+×B292.0918.000.180.0590.020.0==×+×B388.0877.000.170.0590.030.0==×+×B30.88B20.92B10.970.091P(10)2P(80)1P2P21PPBTPRLFPRRLFPRP×+×+×=1BFNRLTNRRLTNRP×+×-×=2(13-15)FNRTNRFPRTPR=B=L=R13-5()1480.0=B10.0=L01.0=R=TPR0.90=FPR0.25=TNR0.75=FNR0.101P2P(13-15)05.004698.001.090.010.025.001.010.025.01==×+×+×=P,42.0419355.080.010.010.075.001.010.075.02==×+×-×=P5425%~42%(series)(parallel)SASSPSSROCSASROCSAS6.10()LOGISTIC(1-)1513-3ROCSAS13-113-102groupcasecontrol091113-5test_val(percentconcordant)90.0Somer’sD0.80(percentdiscordant)10.0Gamma0.80(percenttied)0.0Tau-a0.444(pairs)20c0.90c0.900ROC()(1)()ROC13-5ROCSAS13-213-102group1group015test_val(03)FREQ0407081613-5ROC0.89313-6()(test_val)test_valtest_valLOGISTICDESCENDINGSPSSROCSPSS9.0ROCSPSS10.0ROC(\\)………,,…13-31(3)2ROCSAS6.12LOGISTICSPSS10.01.100(1)Youden()(2)(13-10)(13-11)()10%()171001002002.10034()66()(MCV)ROCMCVMCV5258626567686971727273737475767777787980808181818283848585868888909260666869717173747474767777777778787979808081818182828383838383838384848484858586868687888888898989909091919293939