三种血清肿瘤标志物在卵巢子宫内膜异位囊肿诊断及鉴别诊断中的应用价值

发布时间：2018-06-19 22:17

本文选题：肿瘤标志物 + 卵巢子宫内膜异位囊肿　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:卵巢子宫内膜异位囊肿(Ovarian endometriosis cysts)是子宫内膜异位症的常见类型,多发生于育龄女性,可导致育龄女性不孕不育,甚至引起女性慢性盆腔痛,严重影响患者的生活质量。腹腔镜下卵巢内异症囊肿剥除术是主要的治疗方法,同时,临床上使用GnRH-a(促性腺激素释放激素激动剂)药物辅助治疗该疾病。卵巢子宫内膜异位囊肿是行手术治疗,还是药物保守治疗,术前诊断及鉴别诊断非常重要,尤其对于近期有生育要求的女性。目前国内外对卵巢子宫内膜异位囊肿的诊断及鉴别诊断的研究越来越多。本研究主要针对血清CA125、CA199、HE4在该疾病的术前诊断及鉴别诊断中的应用价值做出评估,为了解手术难易程度解,决定术前、术后是否需要辅助GnRH-a药物治疗。方法:回顾性分析及比较经腹腔镜手术治疗并通过病理检查确诊的卵巢子宫内膜异位囊肿患者397例(患病组),卵巢恶性肿瘤72例(病例对照组A),卵巢良性肿瘤87例(只包含卵巢浆液性及粘液性肿瘤,病例对照组B)血液中三种肿瘤标记物的检验结果,并分析三种肿瘤标志物诊断卵巢子宫内膜异位囊肿的敏感性及特异性,以及三种肿瘤标志物在子宫内膜异位囊肿中的鉴别意义。结果:卵巢子宫内膜异位囊肿血清CA125、CA199、HE4检测值的中位数、阳性率分别为38.80U/ml、62.72%,32.39U/ml、45.34%,37.20pmol/L、0.50%,卵巢恶性肿瘤血清CA125、CA199、HE4检测值的中位数为136.40U/ml,15.58U/ml,89.20pmol/L;卵巢良性囊肿血清CA125、CA199、HE4检测值的中位数分别为12.20U/ml,13.06U/ml,35.40pmol/L。卵巢子宫内膜异位囊肿血清CA125、CA199、HE4检测值的灵敏度、特异度分别为62.70%、61.00%,45.30%、79.20%,0.50%、74.80%。三种血清肿瘤标志物联合诊断子宫内膜异位囊肿的阳性率、灵敏度、特异度分别为73.55%、73.60%、48.40%;患病组的血清CA125及HE4水平的中位数明显低于病例对照组A(P0.001),差异具有统计学意义。患病组的血清CA125及CA199水平的中位数明显高于病例对照组B(P0.001),差异具有统计学意义。患病组的血清HE4水平的中位数与病例对照组B比较差异无统计学意义(P0.001)。病例对照组A的血清HE4水平的中位数与患病组比较有统计学意义(P0.001)。病例对照组A的血清CA125、CA199及HE4水平中位数明显高于病例对照组B,差异有统计学意义(P0.001)。结论:测定血清CA125、CA199水平可以协助诊断子宫内膜异位囊肿,判断病情并结合患者个体情况指导治疗,三种血清肿瘤标志物联合诊可提高诊断的灵敏度。利用血清CA125及CA199鉴别子宫内膜异位囊肿及良性卵巢囊肿具有明显意义。虽然血清HE4对于诊断子宫内膜异位囊肿无明显意义,但对于鉴别诊断恶性卵巢囊肿具有明显意义。
[Abstract]:Objective: Ovarian endometriosis cysts is a common type of endometriosis, which usually occurs in women of childbearing age. It can lead to infertility in women of reproductive age, and even cause chronic pelvic pain in women, which seriously affects the quality of life of patients. Laparoscopic excision of ovarian endometriosis cysts is the main treatment, and GnRH-a (gonadotropin releasing hormone agonist) is used as adjuvant in clinical treatment of the disease. The preoperative diagnosis and differential diagnosis of ovarian endometriosis cyst is very important, especially for women with fertility requirement in the near future. At present, there are more and more researches on the diagnosis and differential diagnosis of ovarian endometriosis cysts at home and abroad. The purpose of this study was to evaluate the value of serum CA125 and CA199HE4 in the preoperative diagnosis and differential diagnosis of the disease. Methods: retrospective analysis and comparison of 397 cases of ovarian endometriosis cysts diagnosed by laparoscopy and pathological examination were made (group B, n = 72), ovarian malignant tumor (n = 72) (case control group), benign ovarian tumor (n = 87). (including ovarian serous and mucinous neoplasms only, The sensitivity and specificity of the three tumor markers in the diagnosis of ovarian endometriosis cysts were analyzed. And the differential significance of three tumor markers in endometriosis cyst. Results: the median of serum CA125U / CA199H4 was 38.80Uml / ml 62.72and 32.39 U / ml = 45.34U / L = 37.20pmol / L = 0.50, the median of serum CA125U / P / CA199HE4 was 136.40U / ml / L 15.58UmlP / L = 89.20pmol / L, and the median of serum CA125U / ml CA199HE4 was 12.20U / ml 13.06U / ml 13.40Umol / L / L, respectively. The sensitivity and specificity of serum CA125 and CA199HE4 in ovarian endometriosis cysts were 62.70 and 61.00, respectively. The positive rate, sensitivity and specificity of the three serum tumor markers in the diagnosis of endometriosis cysts were 73.55 and 73.600.48.40.The median of serum CA125 and HE4 levels were significantly lower than those of the control group (P 0.001). The median of serum CA125 and CA199 levels in the disease group was significantly higher than that in the case control group (P 0.001). There was no significant difference in the median of serum HE4 level between the patient group and the case control group B (P 0.001). The median level of serum HE4 in the case control group was significantly higher than that in the patient group (P 0.001). The median of serum CA125, CA199 and HE4 levels in the case control group was significantly higher than that in the case control group B, and the difference was statistically significant (P 0.001). Conclusion: the determination of serum CA125 and CA199 levels can help to diagnose endometriosis cysts, judge the condition of endometriosis and guide the treatment combined with the individual condition of the patients. The combined diagnosis of three serum tumor markers can improve the sensitivity of diagnosis. It is significant to distinguish endometriosis cyst from benign ovarian cyst by serum CA125 and CA199. Although serum HE4 is of no significance in the diagnosis of endometriosis cysts, it is of great significance in differential diagnosis of malignant ovarian cysts.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.71

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