多指标联合超声在卵巢恶性肿瘤诊治中的临床意义

发布时间：2018-01-19 13:13

本文关键词： 卵巢肿瘤血清肿瘤标志物彩色多普勒超声早期诊断　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:卵巢癌发病隐匿,缺乏早期筛查手段,大多数患者一经发现即是晚期,这使得卵巢癌具有高发病率、高死亡率、低生存率特点.因此寻找特异性强、灵敏度高、简单方便、无创伤或创伤性小、可重复的检测方法是目前国内外学者关注的焦点。本研究旨在探讨卵巢癌的诊断方式,如彩色多普勒超声、CA199、CA125、HE4、ROMA指数在卵巢肿瘤诊治中的临床意义,进而为临床卵巢癌诊断的提供可靠参考。方法:本研究选取2015年10月-2017年1月就诊于皖南医学院附属弋矶山医院妇产科并接受手术治疗且术后病理为卵巢肿瘤的248例患者,以及同期在本院体检中心体检的40例资料完整的健康者为研究对象,共288例。临床资料经统计分为三组,即卵巢恶性肿瘤组、卵巢良性肿瘤组、健康对照组。收集各研究对象的既往病史、手术史、年龄、绝经状态、彩色多普勒超声结果(包括肿块体积、最大直径、境界、血供、囊实性以及有无盆腔积液)、血清CA199、CA125、HE4值、ROMA值,术后病理诊断、肿瘤的分期等。通过统计学方法比较各指标单一或联合诊断的灵敏度、特异度、阳性预测值、阴性预测值等,来探讨单一指标及多指标联合应用的的临床价值。结果:1.本研究卵巢恶性肿瘤组49例;卵巢良性肿瘤组199例;健康对照组40例,共计288例.其中卵巢恶性肿瘤患者年龄分布为16-81岁,平均年龄为:53.94±11.33岁;中位数年龄为53岁。卵巢良性疾病组年龄分布为18-75岁,平均年龄为:40.88±15.36岁;中位数年龄为41岁;健康对照组分布20-78岁,平均年龄37.82±12.28岁,中位数年龄37岁。2.血清CA125、HE4水平、ROMA指数在卵巢良恶性肿瘤及健康对照组三组间差异具有统计学意义(P=0.0000.001),而CA199在三组间差异无统计学意义(P=0.4680.05)。卵巢癌组血清CA125、HE4和ROMA值表达水平较高,且明显高于卵巢良性肿瘤组,差异均具有显著统计学意义(P=0.000,0.000,0.0000.001)。卵巢恶性肿瘤组血清CA125、HE4水平、ROMA指数与女性健康对照组比较,差异均具有显著统计学差(P=0.000,0.000,0.0000.001)。卵巢良性肿瘤组血清CA125、HE4、水平、ROMA指数与女性健康对照组比较,差异无统计学意义(P=0.086,0.725,0.8860.05)。3.绘制血清CA125、HE4、ROMA指数的ROC曲线,计算曲线下面积(AUC),结果分别为0.857,0.823,0.846,(P=0.000,0.000,0.0000.001),但CA199的AUC面积只有0.467,(P=0.4680.05)。表明血清CA125,HE4,ROMA指数单独应用于卵巢癌早期诊断,准确度均较高,有一定的临床意义;但不建议单独应用血清CA199作为卵巢癌早期诊断指标。4.彩色多普勒超声与ROMA联合应用的灵敏度和阴性预测值分别为93.88%和96.99%,表明对卵巢癌早期诊断临床价值较高。结论:1.CA199,CA125,HE4,ROMA值、超声单一应用时,ROMA灵敏度和阴性预测有明显优势,HE4的特异性、阳性预测值、阴性预测值、准确度优势明显.2.多指标联合检测时,超声+ROMA联合检测时较CA199+CA125,CA125+HE4,超声+CA125+HE4理想,可作为卵巢癌筛查的理想组合。3.血清CA125,HE4,ROMA的ROC曲线下面积(AUC)分别为0.857,0.823,0.846,(P=0.000,0.000,0.0000.001),因此血清CA125,HE4,ROMA诊断卵巢癌良恶性具有一定的临床价值。
[Abstract]:Objective: ovarian cancer incidence of occult, lack of early screening, found that most of the patients are advanced, which makes ovarian cancer with high incidence, high mortality and low survival rate. So looking for strong specificity, high sensitivity, simple and convenient, no trauma or traumatic small, reproducible assay method is currently the focus of scholars at home and abroad. The purpose of this study is to investigate the diagnosis of ovarian cancer, such as CA199, color Doppler ultrasound, CA125, HE4, ROMA and clinical significance in the diagnosis and treatment of the ovarian tumor index for clinical diagnosis of ovarian cancer, and provide reliable reference. Methods: This study selected the October 2015 -2017 year in January in Wangnan Medical College Hospital Affiliated to the Rocky Mountain hospital of Obstetrics and Gynecology and surgery and postoperative pathology in 248 cases of ovarian cancer patients, and the same period in the hospital physical examination center of the complete data of 40 cases of healthy subjects were as the research object. 288 cases of clinical data. The statistics are divided into three groups, namely ovarian malignant tumor group, benign ovarian tumor group and healthy control group. Past medical history, collected on the study history of surgery, age, menopausal status, the results of color Doppler ultrasound (including tumor size, maximum diameter, realm, blood supply, cystic and there is no pelvic effusion), serum CA199, CA125, HE4 value, ROMA value, postoperative pathological diagnosis, staging of tumor. The sensitivity, statistical methods to compare the index of single or combined diagnostic specificity, positive predictive value, negative predictive value, to explore the clinical value of combined application of single index and multi index the results of this study: 1.. Ovarian cancer group 49 cases; 199 cases of benign ovarian tumor group and healthy control group; 40 cases, a total of 288 cases of ovarian malignant tumor. The age distribution of the patients was 16-81 years old, the average age was 53.94 + 11.33 years; the median age was 53 years. Ovarian benign disease group age 18-75 years old, the average age was 40.88 + 15.36 years; the median age was 41 years; the healthy control group distribution of 20-78 years old, mean age 37.82 + 12.28 years old, the median age was 37 years.2. serum CA125, HE4 level, ROMA index comparison difference was statistically significant between the three groups in benign and malignant group ovarian tumor and health (P=0.0000.001), and CA199 was no significant difference between the three groups (P=0.4680.05). The ovarian cancer group serum CA125, HE4 and ROMA high expression level, and was significantly higher than benign ovarian tumor group, the difference was significant statistical significance (P=0.000,0.000,0.0000.001). The ovarian cancer group serum CA125, HE4 levels the ROMA index, and the health of women compared to the control group, the difference has statistically significant difference (P=0.000,0.000,0.0000.001). The ovarian benign tumor group serum CA125, HE4 level, ROMA index and female healthy control group And there was no significant difference in serum CA125.3. (P=0.086,0.725,0.8860.05) HE4, ROC drawing, curve ROMA index, calculate the area under the curve (AUC), the results were 0.857,0.823,0.846, CA199 (P=0.000,0.000,0.0000.001), but the area is only 0.467 AUC (P=, 0.4680.05). The results indicated that serum CA125, HE4, ROMA index applied to early diagnosis ovarian cancer, the accuracy is high, has certain clinical significance; but it is not recommended to separate application of serum CA199 as the sensitivity and negative predictive index for diagnosis of.4. combined with color Doppler ultrasound and the application of ROMA in the early stage of ovarian cancer were 93.88% and 96.99%, that of higher clinical value in early diagnosis of ovarian cancer. Conclusion: 1.CA199, CA125 HE4, ROMA, ultrasound, single application, ROMA sensitivity and negative predictive advantages, specific HE4, positive predictive value, negative predictive value, accuracy of the obvious advantages of.2. multi index combined detection When combined with ultrasonic testing +ROMA compared with CA199+CA125, CA125+HE4, +CA125+HE4, ultrasound can be used as the ideal, the ideal combination of screening for ovarian cancer serum.3. CA125, HE4 ROC, the area under the ROMA curve (AUC) were 0.857,0.823,0.846 (P=0.000,0.000,0.0000.001), the serum CA125, HE4, ROMA in the diagnosis of benign and malignant ovarian cancer has some clinical value.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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