CA125、HE4及ROMA指数在早期卵巢浆液性癌诊断中的价值探讨

发布时间：2018-03-21 07:14

本文选题：糖链抗原125　切入点：人附睾蛋白4　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨CA125、HE4及ROMA指数在早期卵巢浆液性癌诊断中的价值。方法:回顾性分析2013年1月-2016年12月就诊于新疆肿瘤医院经病例确诊的386例卵巢疾病包括早期卵巢浆液性癌组86例I期40例,II期46例)、晚期卵巢浆液性癌组105例(III期92例,IV期13)、卵巢浆液性囊腺瘤组94例和卵巢子宫内膜异位囊组101例术前CA125和HE4血清水平及ROMA指数值,通过对各组间血清水平值、阳性率及灵敏度、特异度等指标的比较,探讨单一肿瘤标记物检测和联合检测在早期卵巢浆液性癌诊断中的价值。结果:(1)血清CA125值和HE4值及ROMA指数值在早期卵巢癌组与卵巢子宫内膜异位囊肿组及卵巢浆液性囊腺瘤组中比较(均P=0.000)均P0.05,提示有助于早期卵巢浆液性癌的筛查。(2)CA125在早期卵巢癌组的阳性率(80.23%)高于ROMA指数(77.91%)和HE4(63.95%);CA125在早期卵巢癌组与卵巢子宫内膜异位囊肿组的阳性率相比(2?=2.004,P=0.106),P0.05,提示尚不能认为CA125的阳性率有差异;HE4和ROMA指数在早期卵巢癌组与卵巢浆液性囊腺瘤组及卵巢子宫内膜异位囊肿组的阳性率相比较(2?H E4=57.295、80.900,P=0.000、0.000;2?ROMA=91.891、67.929,P=0.000、0.000)均P0.05,差异有统计学意义。(3)HE4在卵巢浆液性癌组中的阳性率I期与II期、III期和IV期相比(2?=8.782、24.952、11.304,P=0.003、0.000、0.000)均P0.05,有统计学差异;ROMA指数在卵巢浆液性癌组中的阳性率I期与III期和IV期相比(2?=23.534、4.511,P=0.000、0.030)均P0.05,有统计学差异;CA125在卵巢浆液性癌组不同期别中的阳性率(2?=2.188,P=0.135)P0.05,提示CA125在卵巢癌组的阳性率与分期无明显相关性。(4)单一肿瘤标记物检测:HE4诊断早期卵巢癌组的特异度(95.90%)、阳性预测值(87.30%)及诊断准确度(86.12%)均高于CA125(51.28%、42.07%、60.14%)和ROMA指数(75.90%、58.77%、76.51%);ROMA指数的阴性预测值(88.62%)高于CA125(85.47%)和HE4(85.78%);R OMA指数的ROC-AUC(0.938)均大于HE4(0.908)和CA125(0.804)。(5)肿瘤标记物联合检测:CA125、HE4和ROMA指数三者均阳性时较一种或两种肿瘤标记物阳性诊断早期卵巢浆液性癌的灵敏度(53.49%vs9.30%vs11.63%)、特异度(98.46%vs98.46%vs93.85%)、阳性预测值(93.88%vs25.00%vs33.33%)、阴性预测值(82.76%vs69.31%vs69.58%)、诊断准确性(84.70%vs68.68%vs67.26%)均增高。结论:(1)CA125、HE4和ROMA指数三者均阳性时更有助于早期卵巢浆液性癌的筛查、诊断。(2)HE4和ROMA指数诊断早期卵巢浆液性癌的价值优于CA125。(3)C A125对早期浆液性卵巢癌有一定的诊断价值,更有助于临床良性疾病的鉴别诊断;(4)HE4在卵巢癌中的阳性率随卵巢癌期别的增加而升高。
[Abstract]:Objective: to evaluate the value of CA125HE4 and ROMA index in the diagnosis of early ovarian serous carcinoma. Methods: a retrospective analysis of 386 cases of ovarian diseases, including early ovarian plasma, diagnosed in Xinjiang tumor Hospital from January 2013 to December 2016, was conducted. In liquid carcinoma group, there were 86 cases of stage I, 40 cases of stage II, 46 cases of stage II, 105 cases of advanced ovarian serous carcinoma, 105 cases of stage III, 92 cases of stage IV, 94 cases of ovarian serous cystadenoma, and 101 cases of endometriosis of ovary. The serum levels of CA125 and HE4 and ROMA index were measured before operation. The serum level, positive rate, sensitivity and specificity of each group were compared. To evaluate the value of single tumor marker detection and combined detection in the diagnosis of early ovarian serous carcinoma. Results: 1) Serum CA125, HE4 and ROMA index in early ovarian cancer and ovarian endometriosis cyst and ovarian plasma. The positive rate of cystadenoma (P 0.000) was higher than that of ROMA index (77.91%), suggesting that the positive rate of CA125 in early ovarian cancer was higher than that in early ovarian cancer group (P < 0.05), suggesting that the positive rate of CA125 in early ovarian cancer group was higher than that in early ovarian cancer group and ovarian endometriosis cyst group (P < 0.05). The positive rate of CA125 in early ovarian cancer group was higher than that in early ovarian cancer group (77.91%) and that in early ovarian cancer group was higher than that in ovarian endometriosis cyst group (P < 0.05). It is suggested that there is no difference in the positive rate of CA125 between early ovarian cancer group and ovarian serous cystadenoma group and endometriosis cyst group. HE4 (57.295N) 80.900 (P0. 000 ~ 0. 000) 2? Roma 91.891n 67.929 (P 0.0000.000), the difference was significant (P 0.05). The positive rate of Ovarian serous carcinoma in stage I and II, stage III and stage IV were significantly higher than that in stage II, stage III and stage IV, respectively. The positive rate of P0.05in stage I was significantly higher than that in stage IV, and the positive rate in stage I was significantly higher than that in stage IV. The positive rate of Roma index in ovarian serous carcinoma group was significantly higher than that in III stage and stage IV. There was a significant difference in the positive rate of Roma index between stage I and stage IV of ovarian serous carcinoma (P 0.05, P 0.05, P 0.05, P < 0.01; P < 0.01; P < 0.05; P > 0.05; P > 0.05; P > 0.05; P > 0.05; P > 0.05; P > 0.05 respectively). The positive rate of CA125 in ovarian serous carcinoma group was 2? Conclusion: the positive rate of CA125 in ovarian cancer group has no significant correlation with the stage. 4) the specificity of the single tumor marker in the diagnosis of early ovarian cancer is 95.9090. (the positive predictive value is 87.30), and the diagnostic accuracy is 86.12).) it is higher than CA1251.281.2842.0742.0740.1440.14.) and the ROMA index is 75.9058.777.78.7777.51and the Roma index is 75.9058.777.75% higher than that of CA1251.281.2852.070.140.14) and the ROMA index is 75.9058.777.75% higher than that of CA12551.2852.07% (60.140.14). The negative predictive value (88.62) was higher than that of CA125 (85.47) and the ROC-AUC0. 938 (R OMA index of HE4) was higher than that of HE4 (0.908) and CA125 (0.804). 5) when the tumor markers were positive, the sensitivity of one or two tumor markers was higher than that of one or two tumor markers in the diagnosis of early ovarian serous carcinoma. 53.49vs9.30 vs 11.63m, the specificity of 98.46m is about 98.46vs93.85. the positive predictive value is 93.88vs25.00 and the negative predictive value is 82.76vs69.31vs69.58.The diagnostic accuracy is 84.70vs68.68vs67.26.Conclusion it is more helpful to screen early serous carcinoma when the positive ones are positive. The diagnostic value of HE4 and ROMA index in the diagnosis of early ovarian serous carcinoma is better than that of CA125.(3)C A125 in the diagnosis of early serous ovarian carcinoma. It is helpful for differential diagnosis of clinical benign diseases. The positive rate of PHE4 in ovarian cancer increases with the increase of other stages of ovarian cancer.
【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】：R737.31

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