血浆D-二聚体水平与乳腺癌腋窝淋巴结转移的相关性研究

发布时间：2018-01-06 18:49

本文关键词：血浆D-二聚体水平与乳腺癌腋窝淋巴结转移的相关性研究　出处：《延安大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨血浆D-二聚体水平与乳腺癌腋窝淋巴结转移的关系,为预测乳腺癌腋窝淋巴结转移状态提供依据,避免不必要的淋巴清扫术。方法1.选取2013年5月至2015年1月在延安大学附属医院就诊的女性病例159例,其中①乳腺癌组73例,术前无相关抗肿瘤治疗;②乳腺良性疾病组36例;③正常对照组50例,来源于体检中心体检的健康女性。收集乳腺癌组(术前一周)、乳腺良性疾病组、正常对照组三组患者肘前静脉血,使用日本SYSMEX(希森美康)株式会社生产的D-二聚体测定盒测定血浆D-二聚体水平,方法为免疫比浊法。2.对所收集病例患者的一般资料(年龄、月经状况等)、临床及病理资料(肿瘤大小、病理分型、是否淋巴结转移、淋巴结转移个数、激素受体、癌基因等)进行系统的整理。3.运用统计软件SPSS22.0进行统计分析:多组间比较采用单因素方差分析,两组间比较采用t检验,各组间频数比较采用卡方检验。D-二聚体水平与腋窝淋巴结转移个数之间的相关性应用Spearman相关分析。多因素分析应用非条件logistic回归分析。P0.05为差异有统计学意义。结果1.乳腺良性疾病组和正常对照组的血浆D-二聚体水平明显低于乳腺癌组,差异有统计学意义(P0.01)。乳腺良性疾病组的D-二聚体水平与正常对照组的D-二聚体水平相比较,差异无统计学意义(P0.05)。2.腋窝淋巴结转移阳性组D-二聚体水平高于腋窝淋巴结转移阴性组,差异有统计学意义(P0.01)。3.腋窝淋巴结转移状态与乳腺癌患者肿瘤大小、病理类型及D-二聚体水平有关。腋窝淋巴结转移率随着原发肿瘤直径的增大而增加(P0.05);病理类型越差,腋窝淋巴结转移率显著增加(P0.01)。4.绝经、肿瘤大小、病理类型、血浆D-二聚体水平与腋窝淋巴结转移个数相关,其中肿瘤大小、病理类型、血浆D-二聚体水平与腋窝淋巴结转移个数显著相关(P0.01)。5.多因素分析显示:原发肿瘤的病理类型、血浆D-二聚体水平是腋窝淋巴结转移的危险因素(OR=7.464、6.470,P0.05)。6.血浆D-二聚体水平诊断乳腺癌腋窝淋巴结转移时的ROC曲线下面积(AUC)为0.689,以0.455ug/ml为最佳诊断分界点,灵敏度为52.3%,特异度为86.2%。结论1.乳腺癌患者血浆D-二聚体水平较乳腺良性疾病患者和正常体检者升高。2.乳腺癌血浆D-二聚体水平与腋窝淋巴结转移状态有关,腋窝淋巴结阳性的患者较腋窝淋巴结阴性的患者D-二聚体水平升高。3.乳腺癌腋窝淋巴结转移个数与血浆D-二聚体水平呈正相关。4.乳腺癌肿瘤大小、病理类型、D-二聚体水平与腋窝淋巴结转移率呈正相关,与腋窝淋巴结转移个数亦相关。5.病理类型、血浆D-二聚体水平是乳腺癌腋窝淋巴结转移的危险因素。6.血浆D-二聚体水平对判断乳腺癌腋窝淋巴结转移状态有一定临床价值。7.乳腺癌组织中ER、PR、Her-2的表达与腋窝淋巴结转移无关。
[Abstract]:Objective to investigate the relationship between plasma D-dimer level and axillary lymph node metastasis in breast cancer and to provide evidence for predicting axillary lymph node metastasis in breast cancer. Methods 1. From May 2013 to January 2015, 159 female patients were selected from the affiliated Hospital of Yan'an University, including 73 cases of breast cancer. 2. There was no related antitumor therapy before operation. 2benign breast disease group: 36 cases; 3Fifty healthy women from the physical examination center in the normal control group were collected the blood of the anterior elbow vein of the breast cancer group (one week before operation, the benign breast disease group and the normal control group). The plasma levels of D- dimer were determined by using a D- dimer measuring box produced by SYSMEX (Japan) Co., Ltd. Methods the general data (age, menstrual status, etc.), clinical and pathological data (tumor size, pathological type, lymph node metastasis and number of lymph node metastasis) of the patients were collected by immunoturbidimetry. Hormone receptor, oncogene, etc. (3. Statistical software SPSS22.0 for statistical analysis: multigroup comparison using single factor analysis of variance, the comparison between the two groups using t-test. Frequency comparison among groups using chi-square test. D- dimer level and axillary lymph node metastasis number correlation using Spearman correlation analysis. Multivariate analysis using non-conditional logistic. Regression analysis. P0.05 for the difference was statistically significant. Results 1. The level of plasma D-dimer in benign breast disease group and normal control group was significantly lower than that in breast cancer group. 2. The difference was statistically significant (P 0.01). The level of D-dimer in benign breast disease group was compared with that in normal control group. The level of D-dimer in positive axillary lymph node metastasis group was higher than that in axillary lymph node metastasis negative group. The difference was statistically significant (P < 0.01). Axillary lymph node metastasis was associated with tumor size in breast cancer patients. The incidence of axillary lymph node metastasis increased with the increase of the diameter of the primary tumor (P 0.05). The worse the pathological type, the higher the rate of axillary lymph node metastasis (P 0.01). The size of menopause, tumor size, pathological type and plasma D-dimer level were correlated with the number of axillary lymph node metastasis. The tumor size, pathological type, plasma D-dimer level and the number of axillary lymph node metastasis were significantly correlated with the tumor size, pathological type and the number of axillary lymph node metastasis. Multivariate analysis showed that: the pathological type of primary tumor. Plasma D-dimer level was a risk factor for axillary lymph node metastasis. The area under ROC curve of plasma D-dimer level in diagnosis of axillary lymph node metastasis of breast cancer was 0.689. The best diagnostic boundary point was 0.455ugrml, and the sensitivity was 52.3%. The plasma D-dimer level of breast cancer patients is higher than that of benign breast disease patients and normal people. 2. Breast cancer plasma D-dimer level and axillary lymph node metastasis status. 2. Yes. The level of D-dimer in patients with positive axillary lymph nodes was higher than that in patients with negative axillary lymph nodes. There was a positive correlation between the number of axillary lymph node metastasis and plasma levels of D-dimer in breast cancer. The level of D-dimer was positively correlated with the rate of axillary lymph node metastasis and with the number of axillary lymph node metastasis. Plasma D-dimer level is a risk factor for axillary lymph node metastasis in breast cancer. 6. Plasma D-dimer level has certain clinical value in judging axillary lymph node metastasis status of breast cancer .7.ER in breast cancer tissue. . The expression of PRM Her-2 was not related to axillary lymph node metastasis.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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