彩超、CA125、HE4、ROMA在卵巢良恶性肿瘤诊断中的临床应用价值研究

发布时间：2018-01-16 22:22

本文关键词：彩超、CA125、HE4、ROMA在卵巢良恶性肿瘤诊断中的临床应用价值研究　出处：《兰州大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:卵巢癌预后差,致死率高。早发现,早诊断,早治疗是目前卵巢癌的最佳治疗原则。本研究旨在探讨卵巢癌诊断方式:彩色多普勒超声、CA125、HE4、ROMA在卵巢肿瘤诊断中的临床应用价值,进而为临床提供卵巢肿瘤良恶性诊断的可靠参考。方法:以甘肃省人民医院2014.2-2015.3月期间298例因盆腔包块在妇科接受手术治疗的患者和46例本院体检中心体检的健康者为研究对象,收集其彩色多普勒超声结果、血清CA125以及HE4值,并计算ROMA值,以术后病理科临床石蜡结果作为判断标准,计算各项诊断方式单独以及联合诊断的灵敏性、特异度、阳性预测值、阴性预测值等。结果:1.盆腔包块患者年龄分布10~84岁,平均年龄为40.33±13.79岁,其中绝经前246人,绝经后52人;经病理学确诊卵巢恶性肿瘤64例(其中包括浆液性囊腺癌38例、粘液性囊腺癌13例、透明细胞癌3例、未成熟畸胎瘤3例、颗粒细胞瘤2例、支持细胞瘤1例、brener瘤1例、卵黄囊瘤1例、子宫内膜样癌1例、卵巢鳞状细胞癌1例),盆腔良性疾病234例(其中包括卵巢子宫内膜异位囊肿82例、成熟性畸胎瘤25例、囊腺瘤或纤维腺瘤40例、卵巢单纯囊肿54例、输卵管良性疾病33例)。2.卵巢恶性肿瘤组血清CA125、HE4、ROMA值明显高于卵巢良性肿瘤组和正常健康女性组,差异据有统计学意义(P=0.000,0.000,0.000㩳0.05)。3.卵巢良性疾病组血清CA125、HE4、ROMA值与正常健康女性组相比,无统计学差异(P=0.075,0.885,0.8860.05)。4.血清CA125、HE4、ROMA(绝经前后)、彩色多普勒超声、彩色多普勒超声+ROMA,各检测方法在卵巢良恶性肿瘤的预测方面均具有误诊现象。5.彩色多普勒超声具有较高的诊断特异性(91.88%)和阴性预测值(92.27%)。6.血清CA125在卵巢肿瘤诊断中阴性预测值达92.73%,突出明显优势。7.血清HE4在特异性方面突出显著优势,为97.44%。8.对于绝经前、后妇女,ROMA均表现出良好的诊断性能,但从数据的整体分布情况来看,可看出ROMA对于绝经后妇女卵巢良恶性肿瘤诊断方面,更能体现优势。9.绘制血清CA125、HE4、ROMA的ROC曲线,计算曲线下面积(AUC),结果分别为0.857,0.823,0.846(P=0.000,0.000,0.000㩳0.05),均大于0.8,这表明单独使用血清CA125、HE4、ROMA判断卵巢肿瘤良恶性,同样具有较高的准确度。10.根据血清CA125、HE4的ROC曲线,寻找约登指数(r)最大值,得出血清CA125的最大r值为0.617,此时对应的CA125 CUT-OFF值为72.66U/ml;血清HE4的最大r值为0.683,此时对应的HE4 CUT-OFF值为64.50pmol/L。11.彩色多普勒超声与ROMA联合可明显提高卵巢肿瘤的诊断灵敏性(84.38%)和阴性预测值(95.12%)。结论:1.血清CA125在鉴别卵巢肿瘤良恶性方面,建议取72.66U/mL为CUT-OFF值。2.血清HE4在鉴别卵巢肿瘤良恶性方面,建议取64.50pmol/L为CUT-OFF值。3.单独使用血清CA125、HE4、ROMA诊断卵巢良恶性肿瘤,三者均表现出较高的准确度;对于绝经后妇女,ROMA更具有诊断优势。4.彩色多普勒超声联合ROMA,可将两者优势结合,提高卵巢肿瘤良恶性诊断准确率,其应用价值可供临床参考。
[Abstract]:Objective: ovarian cancer has a poor prognosis and high mortality. Early detection, early diagnosis, early treatment is the best treatment of ovarian cancer. This study aimed to investigate the diagnosis of ovarian cancer: color Doppler ultrasound, CA125, HE4, ROMA in the diagnosis of ovarian tumors in clinical application, reliable reference for the diagnosis of benign and malignant. Clinical ovarian cancer. Methods: the people's Hospital of Gansu Province during 2014.2-2015.3 months in 298 cases with pelvic surgery and 46 cases in our hospital physical examination center in gynecological health as the research object, collected the results of color Doppler ultrasound, serum CA125 and HE4 values and ROMA values were calculated as Department of pathology, clinical results of postoperative paraffin standard, the sensitivity, the calculation of the diagnosis methods alone and combined with the specificity, positive predictive value, negative predictive value. Results: 1. patients with pelvic mass and age distribution of 10~8 4 years old, the average age was 40.33 + 13.79 years, including 246 premenopausal and 52 postmenopausal; pathological diagnosis of malignant ovarian tumors in 64 cases (including 38 cases of serous cystadenocarcinoma, mucinous cystadenocarcinoma of 13 cases, 3 cases of clear cell carcinoma, 3 cases of immature teratoma, 2 cases of granular cell tumor support cell tumor in 1 cases, 1 cases, 1 cases of Brener tumor, 1 cases of yolk sac tumor, 1 cases of ovarian endometrioid carcinoma squamous cell carcinoma), pelvic benign diseases in 234 cases (including 82 cases of ovarian endometriotic cyst, 25 cases of mature teratoma, cystadenoma and 40 cases of fibroadenoma, 54 cases of ovary, simple 33 cases of cyst of fallopian tube benign disease).2. ovarian cancer group serum CA125, HE4, ROMA was significantly higher than that of benign ovarian tumor group and healthy women group, the difference has statistical significance (P=0.000,0.000,0.000? 0.05).3. ovarian benign disease group serum CA125, HE4, phase group and normal healthy women value ROMA Than, there was no significant difference in serum CA125 (P=0.075,0.885,0.8860.05).4., HE4, ROMA (menopause), color Doppler ultrasound, color Doppler ultrasound in the prediction of +ROMA, benign and malignant ovarian tumors in various detection methods have specific diagnosis misdiagnosis phenomenon of.5. color Doppler ultrasound has high negative predictive value (91.88%) and (92.27%).6. serum CA125 in diagnosis of ovarian tumors and negative predictive value of 92.73%, highlighting the obvious advantages of.7. serum HE4 outstanding advantages in specific aspects, 97.44%.8. for premenopausal women, after, ROMA showed good diagnostic performance, but the overall distribution of data, we can see that the ROMA for the diagnosis of ovarian cancer in postmenopausal women women with benign and malignant, embodies the advantages of.9. drawing HE4, serum CA125, ROC curve ROMA, calculate the area under the curve (AUC), the results were respectively 0.857,0.823,0.846 (P=0.000,0.000,0.00 0? 0.05), were more than 0.8, which shows that the use of serum CA125, HE4 alone, ROMA judgement of benign and malignant ovarian tumor, also has high accuracy.10. according to the serum CA125, ROC curve HE4, looking for the maximum Youden index (R), the largest R that serum CA125 value is 0.617, which corresponds to CA125 the CUT-OFF value is 72.66U/ml; the maximum r serum HE4 value is 0.683, the corresponding HE4 CUT-OFF 64.50pmol/L.11. value of color Doppler ultrasound combined with ROMA can significantly improve the diagnostic sensitivity of ovarian tumors (84.38%) and negative predictive value (95.12%). Conclusion: 1. the serum CA125 in the differential diagnosis of benign and malignant ovarian tumor, suggest taking 72.66U/mL the CUT-OFF value of serum.2. HE4 in differentiating benign and malignant ovarian tumor, suggest taking 64.50pmol/L CUT-OFF value of single.3. serum CA125, HE4, ROMA in the diagnosis of benign and malignant ovarian tumors, three showed a high degree of accuracy; for postmenopausal women Women, ROMA is more diagnostic advantage..4. color Doppler ultrasound combined with ROMA can combine the advantages of both, improve the accuracy of diagnosis of benign and malignant ovarian tumors, and its application value can be used for clinical reference.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.31

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