多项指标在肝癌早期诊断中的比较研究

发布时间：2018-02-05 00:17

  本文关键词： 肝癌临床诊断 cfDNA 多肿瘤标志物 ROC曲线 Logistic回归　出处：《浙江理工大学》2017年硕士论文　论文类型：学位论文

【摘要】：肝癌是一种高发病率和高死亡率的恶性肿瘤。在全球范围内,每年都有无数的人死于肝癌。其中,中国是肝癌高发病率的国家,占据了全球约一半的发病人数。而中国的肝癌患者普遍有着慢性乙型肝炎的病史,且大多数经历了肝硬化的过程。因此,在中国患有慢性乙型肝炎的患者以及肝硬化的患者将成为肝癌的高发人群,也是肝癌临床早期诊断的重点人群。然而,肝癌在临床早期隐匿性高,诊断困难,这使得很多的肝癌患者错过了最佳的治疗时期。目前,放射治疗、化学药物治疗以及外科切除手术是治疗肝癌的主要方法。但对于中晚期的肝癌患者来说,这些方法并不能达到治愈肝癌的目的。因此,提高肝癌临床诊断技术就显现出了非常重要的意义。本文采用试剂盒的方法分离和纯化了31名原发性肝癌患者外周血中的cfDNA,并且利用荧光定量PCR技术测定cfDNA的浓度。基于cfDNA的浓度初步评估其在肝癌临床诊断中的价值。之后收集了这31名原发性肝癌患者的临床诊断数据,包括了CT检测、MRI检测、US检测三项影像学检测信息以及性别、年龄、多肿瘤标志物检测等重要的信息。利用Excel、SPSS分析软件对原发性肝癌患者的临床数据进行整理和统计分析。荧光定量PCR的结果显示,31名原发性肝癌患者cfDNA浓度的平均值为121.58 ng/mL,中值为36.2 ng/mL,这一结果比较符合相关研究。临床数据分析结果显示,31名原发性肝癌患者中以男性居多。而从年龄分布上看,年龄在40至60岁的患者居多,该年龄段是肝癌高发的年龄段。40岁以下和60岁以上的患病人数相对较少。肝炎肝硬化情况则为仅1名患者(占3.23%)为非慢性乙型肝炎的患者,其余30名患者(96.77%)均伴有慢性乙型肝炎。25名(80.65%)患者为肝硬化患者,6名(19.35%)患者为非肝硬化患者。该数据表明中国的肝癌患者基本患有慢性乙型肝炎,且多数经历肝硬化过程。根据肝癌临床诊断中血清标志物的正常范围值评估各项指标的临床诊断率。结果显示,在血清标志物中以AFP的诊断率最高,其次为CA19-9和CA242,其余的指标较低。而AFP的肿瘤特异性又低于CA19-9和CA242。本文进一步利用ROC曲线分析AFP、CA242、CA19-9、CA125、CEA、CYFRA21-1、NSE这七项指标在肝癌临床中的诊断价值。结果同样得到,AFP的诊断率最高,其次为CA19-9和CA242,其余的指标较低的结论。并且利用Logistic回归模型综合了AFP、CA242、CA19-9和CEA这四项指标对肝癌临床诊断价值进行评估。结果表明,综合这四项指标后临床诊断率将高于任何单独一项的临床诊断率。
[Abstract]:Liver cancer is a malignant tumor with high morbidity and mortality. Worldwide, millions of people die of liver cancer every year. Among them, China is a country with high incidence of liver cancer. It accounts for about half of the total number of people with liver cancer in the world. Chinese patients with liver cancer generally have a history of chronic hepatitis B, and most of them have gone through the process of cirrhosis. In China, patients with chronic hepatitis B and patients with liver cirrhosis will become a high incidence of liver cancer, and will also be the focus of early diagnosis of liver cancer. However, liver cancer is highly occult in the early clinical stage and difficult to diagnose. This leaves many patients with liver cancer missing out on the best treatment period. Currently, radiotherapy, chemotherapy and surgical resection are the main treatments for liver cancer. But for patients with advanced liver cancer, These methods cannot cure liver cancer. It is very important to improve the technique of clinical diagnosis of liver cancer. In this paper, the cfDNAs in peripheral blood of 31 patients with primary liver cancer were isolated and purified by the method of kit, and the concentration of cfDNA was determined by fluorescence quantitative PCR. The value of cfDNA in the clinical diagnosis of hepatocellular carcinoma was preliminarily evaluated based on the concentration of cfDNA. The clinical diagnostic data of the 31 patients with primary liver cancer were collected. Including CT, MRI, MRI, US, three items of imaging information, sex, age, The clinical data of patients with primary liver cancer were collected and statistically analyzed by using Excel SPSS software. The results of fluorescence quantitative PCR showed the average concentration of cfDNA in 31 patients with primary liver cancer. The value was 121.58 ng / mL, and the median value was 36.2 ng / mL, which was consistent with the relevant study. Clinical data analysis showed that the majority of 31 patients with primary liver cancer were male, and in terms of age distribution, The majority of patients aged 40 to 60 had a high incidence of liver cancer. The number of patients under 40 years of age and over 60 years of age was relatively low. The incidence of cirrhosis was only one patient (3.23%) with non-chronic hepatitis B. The remaining 30 patients with chronic hepatitis B (80.65) and the patients with cirrhosis (6 / 19.35) are non-cirrhosis patients. The data show that Chinese patients with liver cancer are basically suffering from chronic hepatitis B. According to the normal range of serum markers in the clinical diagnosis of liver cancer, the clinical diagnosis rate of each index was evaluated. The results showed that the diagnostic rate of AFP was the highest among the serum markers. The other indexes were CA19-9 and CA242, and the tumor specificity of AFP was lower than that of CA19-9 and CA242.In this paper, we further use ROC curve to analyze the diagnostic value of CA19-9 CA242CA19-9 and CA125CEACAFRA21-1NSE in the clinical diagnosis of hepatocellular carcinoma. Results the diagnostic rate of AFP was also the highest. Secondly, CA19-9 and CA242, and the conclusion that the other indexes were lower. The four indexes AFPCA242CA19-9 and CEA were synthesized by using Logistic regression model to evaluate the clinical diagnosis value of HCC, and the results showed that there was no significant difference between AFPCA242CA19-9 and CA242CA19-9 in clinical diagnosis of HCC. The clinical diagnosis rate after these four indexes is higher than that of any single item.
【学位授予单位】：浙江理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
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本文编号：1491568