BTA、彩超、尿细胞学联合检查诊断膀胱癌的临床价值

发布时间：2018-03-04 05:18

本文选题：膀胱癌　切入点：彩超　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨膀胱肿瘤抗原(BTA)、泌尿系彩超、尿脱落细胞学联合检查在膀胱癌诊断中的价值。方法:前瞻性研究了自2016年3月起就诊于吉林大学白求恩第三医院的50例膀胱癌疑似患者,这些患者均有不同程度的间歇性无痛肉眼血尿伴或不伴尿频尿急尿痛等与膀胱癌相关的症状,并依据排除标准排除了不合规患者。对这些患者均给予尿常规、尿细胞学、尿BTA、经腹泌尿系彩超、膀胱镜等相关检查,观察各检查项目的灵敏度、特异度及诊断符合率,并通过之间的相互联合检验,比较联合后灵敏度的变化。结果:50例膀胱癌疑似患者中最终经膀胱镜病理确诊为膀胱移行细胞癌34例(低级别12例、高级别22例)。泌尿系统良性疾病16例(分别可见乳头状瘤、腺性膀胱炎、膀胱炎肉芽肿)。本组研究中可见彩超灵敏度为70.58%,特异度93.75%,存在1例假阳性病例;尿脱落细胞灵敏度为29.41%,特异度93.75%,也存在1例假阳性,且该例患者尿BTA stat也为阳性,需密切随访;BTA stat灵敏度达为76.47%,特异度为81.25%。三者联合检查诊断出膀胱肿瘤32例,联合诊断的灵敏度为94.12%,与各单项检查比较,均有统计学差异(P0.05),说明三者联合后灵敏度提高,更利于膀胱癌的检出。三者联合后与膀胱镜比较,差异无显著性意义(P0.05),说明三者联合后的灵敏度与膀胱镜相似,认为三者联合检查是便利、有效、无创的临床检查方法,对于有膀胱镜禁忌或者强烈排斥膀胱镜检的患者可考虑通过给予三项检查联合的方式暂缓或减少膀胱镜检查次数,如联合检查结果阳性,需再行膀胱镜病理活检确诊。其中传统的彩超与尿细胞学联合后的灵敏度为76.47%,与膀胱镜检查比较存在显著统计学差异(P=0.0080.01),再联合尿BTA后才可达到膀胱镜检的水平,说明对于疑似膀胱癌患者在给予彩超和尿细胞学检查基础上有必要加行BTA检查,BTA在临床引用中存在实用价值,值得推广。BTA stat在膀胱癌分级中的灵敏度比较存在统计学差异(Fisher精确概率法,P=0.0130.05),认为BTA stat在高级别肿瘤表现出更高的灵敏度;而BTA stat在不同分期的肿瘤中,灵敏度差异无统计学意义(Fisher精确概率法,P0.05),认为诊断不同分期肿瘤的灵敏度相似。结论:BTA stat作为一种新的、敏感度高、特异性中等的无创性尿膀胱肿瘤标志物,通过与彩超、尿细胞学联合可提高膀胱癌检出率,并能起到部分替代膀胱镜检查的效果,具有广阔的应用前景。
[Abstract]:Objective: to study the bladder tumor antigen (BTAA), urinary system color Doppler ultrasound (CDFI). The value of combined urine exfoliative cytology in the diagnosis of bladder cancer methods: a prospective study was conducted on 50 suspected bladder cancer patients who had been admitted to Bai Qiuen third Hospital Jilin University since March 2016. These patients all had intermittent painless hematuria with or without frequent urinal pain and other symptoms related to bladder cancer, and excluded irregular patients according to the exclusion criteria. These patients were given routine urine routine, urine cytology, urine cytology, etc. The sensitivity, specificity and diagnostic coincidence rate of each examination item were observed by transabdominal urography, cystoscopy and so on. Results 34 cases of bladder transitional cell carcinoma (12 cases of low grade, 22 cases of high grade) and 16 cases of benign diseases of urinary system (papilloma) were diagnosed by cystoscopy. In this study, the sensitivity of color Doppler ultrasound was 70.58, the specificity was 93.75, there was a false positive case, the sensitivity of exfoliated cells in urine was 29.41, the specificity was 93.75 and there was a false positive in one case, and the urine BTA stat was also positive in this case. The sensitivity of BTA stat was 76.47 and the specificity was 81.25. 32 cases of bladder neoplasms were diagnosed by the three methods, and the sensitivity of combined diagnosis was 94.12. Compared with each single examination, there was statistical difference (P0.05), which indicated that the sensitivity of the three methods was improved after the combination of the three methods. Compared with cystoscopy, there was no significant difference among the three groups, indicating that the sensitivity of the three combined methods was similar to that of cystoscopy, and that the combined examination was a convenient, effective and non-invasive clinical examination method. Patients with cystoscopy taboo or strongly rejected cystoscopy may consider suspending or reducing the number of cystoscopy tests by giving them a combination of three tests, such as positive results. The sensitivity of traditional color ultrasound combined with urocytology was 76.47, and there was a significant difference between cystoscopy and cystoscopy. The level of cystoscopy could be reached only after combined with urinary BTA. It is necessary to add BTA to suspected bladder cancer patients on the basis of color ultrasound and urine cytology. It is worth popularizing the sensitivity of .BTA stat in bladder cancer grade. There is a statistical difference in the sensitivity of .BTA stat in bladder cancer grade. It is concluded that BTA stat has higher sensitivity in high grade tumors, while BTA stat is more sensitive in different stages of bladder cancer. The sensitivity difference was not statistically significant. It was suggested that the sensitivity of stat in the diagnosis of different stages of tumors was similar. Conclusion: BTA stat is a new, highly sensitive, and moderate specific noninvasive marker of urinary bladder tumor. The combination of urinary cytology and cystoscopy can improve the detection rate of bladder cancer and partly replace cystoscopy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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