本文關(guān)鍵詞： 超聲光散射成像 血紅蛋白 血氧飽和度 綜合診斷　出處：《青海大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討超聲光散射成像系統(tǒng)在鑒別乳腺良、惡性腫物的應(yīng)用價(jià)值;利用光散射成像技術(shù)(Diffuse optical tomography,DOT)提供腫物內(nèi)量化的血紅蛋白、血氧飽和度,探討營養(yǎng)代謝對乳腺腫物良惡性的鑒別價(jià)值。方法:收集在2015年6月至2017年1月期間,青海大學(xué)附屬醫(yī)院乳甲外科行乳腺超聲光散射成像檢查并行腫物切除的患者98例,其中共包括102個(gè)乳腺腫物。將超聲光散射成像得出的腫物內(nèi)的量化指標(biāo)(如血紅蛋白總量、血氧飽和度,綜合診斷指數(shù))與病理行相關(guān)性分析,評價(jià)超聲光散射成像系統(tǒng)的靈敏度、特異度、準(zhǔn)確率、陽性預(yù)測值、陰性預(yù)測值。將惡性腫物以最大內(nèi)徑為1cm分為兩組,比較腫物大小與腫物內(nèi)血紅蛋白、血氧飽和度之間的關(guān)系。根據(jù)病理結(jié)果將乳腺腫物分成良、惡性組,將兩組腫物內(nèi)的參數(shù)值(血紅蛋白總量、血氧飽和度)作比較,明確良惡性腫物內(nèi)上述參數(shù)有無差異。分別以血紅蛋白、血氧飽和度、綜合診斷指數(shù)為指標(biāo),繪制受試者工作特征(ROC)曲線,獲得曲線下面積(AUC),以明確上述指標(biāo)(血紅蛋白、血氧飽和度、綜合診斷指數(shù))對乳腺良惡性腫物鑒別價(jià)值,根據(jù)ROC曲線,找出最佳閾值,在該閾值處其相應(yīng)的敏感度和特異度之和最大。結(jié)果:1、102個(gè)乳腺腫物,病理檢出乳腺惡性腫物52個(gè),檢出良性腫物50個(gè)。超聲光散射成像系統(tǒng)檢出乳腺惡性腫物62個(gè),檢出良性腫物40個(gè)。超聲光散射診斷乳腺腫塊的敏感性94.23%,特異性74%,準(zhǔn)確率84.31%,陽性預(yù)測值79.03%,陰性預(yù)測值92.5%。2、將惡性腫物以最大內(nèi)徑為1cm分為兩組,最大內(nèi)徑小于、等于1cm的腫物內(nèi)血紅蛋白:186.67±75.57umol/L,低于最大內(nèi)徑大于1cm的腫物內(nèi)血紅蛋白:241.59±57.72umol/L,其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。最大內(nèi)徑小于、等于1cm的腫物內(nèi)血氧飽和度:1.05±0.25,高于最大內(nèi)徑大于1cm的腫物內(nèi)血氧飽和度:0.87±0.20,其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、良性腫物內(nèi)血紅蛋白值155.16±49.27umol/L,惡性腫物內(nèi)血紅蛋白值225.75±67.46umol/L,其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。良性腫物血氧飽和度值1.23±0.30,惡性腫物血氧飽和度值0.93±0.23,其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4、以血紅蛋白為指標(biāo),繪制ROC曲線,ROC曲線下面積為0.826,最佳閾值為205.5umol/L,其相應(yīng)的敏感度和特異度之和最大,它的特異性是90%,敏感性是71.2%。以血氧飽和度為指標(biāo),繪制ROC曲線,ROC曲線下面積為0.784,最佳閾值為1.075,其相應(yīng)的敏感度和特異度之和最大,它的特異性是78.8%,敏感性是66%。以綜合診斷指數(shù)為指標(biāo)繪制ROC曲線,ROC曲線下面積為0.918,最佳閾值為133.5,其相應(yīng)的敏感度和特異度之和最大,它的特異性是70%,敏感性是100%。結(jié)論:1、超聲光散射診斷乳腺腫物的敏感性及陰性預(yù)測值較高,提示超聲光散射成像系統(tǒng)在乳腺腫物的診斷及鑒別診斷方面可能具有一定的臨床應(yīng)用價(jià)值。2、超聲光散射成像提供的腫物內(nèi)量化指標(biāo)(血紅蛋白總量、血氧飽和度,綜合診斷指數(shù))與腫物的良惡性有直接相關(guān)性,可為臨床診斷及治療提供更多的參考指標(biāo)。3、綜合診斷指數(shù)診斷乳腺良惡性腫瘤價(jià)值明顯高于單一指標(biāo)(血紅蛋白、血氧飽和度),有助于乳腺腫瘤患者的篩查。
[Abstract]:Objective: To investigate the ultrasound scattering imaging system in differential diagnosis of breast benign and malignant tumor, the application value; using light scattering imaging technique (Diffuse optical tomography, DOT) with tumor in quantification of hemoglobin, oxygen saturation, to explore the value of nutrition and metabolism for the identification of benign and malignant breast tumors. Methods: collected in the period from June 2015 to January 2017, Affiliated Hospital of Qinghai University of breast and thyroid surgery for breast ultrasound scattering imaging examination of 98 cases of parallel tumor resection patients, which included 102 breast lesions. The light scattering of ultrasound imaging of tumor in the quantitative indicators (such as total hemoglobin, oxygen saturation, comprehensive diagnosis index) and pathological correlation analysis, sensitivity evaluation of ultrasound scattering imaging system the specificity, accuracy, positive predictive value, negative predictive value. The maximum diameter of 1cm with malignant tumor were divided into two groups, compared with large mass With the small tumor in the relationship between hemoglobin and oxygen saturation. According to the pathological results of breast tumor were divided into benign and malignant groups, two groups within the mass parameter values (total hemoglobin, oxygen saturation) for comparison, clear the parameters of benign and malignant tumor have no difference. At different hemoglobin, oxygen saturation, comprehensive diagnosis index as the index, the receiver operating characteristic (ROC) curve, obtained the area under the curve (AUC), to determine the index (hemoglobin, oxygen saturation, comprehensive diagnosis index) for differential diagnosis of benign and malignant breast tumor, according to the ROC curve, to find the optimal threshold, the threshold of the corresponding sensitivity and specificity and the largest. Results: 1102 breast tumor, malignant tumor of breast pathology was 52, 50 were benign tumor. Ultrasound scattering imaging system detection of malignant breast tumor and 62 benign tumor, 40. Ultrasonic detection The sensitivity of 94.23% light scattering in diagnosis of breast tumors, the specificity was 74%, the accuracy rate was 84.31%, the positive predictive value of 79.03%, negative predictive value of 92.5%.2, the maximum diameter of 1cm with malignant tumor were divided into two groups, the maximum diameter of less than, equal to 1cm tumor in hemoglobin: 186.67 + 75.57umol /L, lower than the maximum diameter greater than 1cm in the tumor hemoglobin: 241.59 + 57.72umol/L, the difference was statistically significant (P0.05). The maximum diameter is less than, equal to 1cm in the tumor blood oxygen saturation: 1.05 + 0.25, higher than the maximum diameter of more than 1cm in the tumor blood oxygen saturation: 0.87 + 0.20, the difference was statistically significant (.3, P0.05) in benign tumor hemoglobin value of 155.16 + 49.27umol/L in 225.75 malignant tumor, hemoglobin + 67.46umol/L, the difference was statistically significant (P0.05). Benign tumor oxygen saturation value of 1.23 + 0.30, malignant tumor blood oxygen saturation value of 0.93 + 0.23, the difference is Statistical significance (P0.05).4, with hemoglobin as the index, the ROC curve, the area under the ROC curve was 0.826, the optimal threshold is 205.5umol/L, its corresponding sensitivity and specificity and the largest, and its specificity is 90%, sensitivity is 71.2%. with oxygen saturation index, ROC curve, the area under ROC curve 0.784, the optimal threshold is 1.075, the sensitivity and specificity of the largest, and its specificity is 78.8%, sensitivity is 66%. with the comprehensive diagnosis index ROC curve, the area under the ROC curve was 0.918, the optimal threshold is 133.5, the sensitivity and specificity of the maximum. The specificity was 70%, sensitivity was 100%. conclusions: 1, predict the sensitivity and negative light scattering of ultrasound in the diagnosis of breast tumor is higher, suggesting that the ultrasonic scattering imaging system may have clinical in diagnosis and differential diagnosis of breast neoplasms The application value of.2 and ultrasound scattering imaging provides quantitative indicators in the tumor (total hemoglobin, oxygen saturation, comprehensive diagnosis index) and tumor has a direct correlation, can provide more.3 reference index for clinical diagnosis and treatment, the comprehensive diagnosis index of diagnosis of benign and malignant breast tumors was significantly higher than that of single value index (hemoglobin, oxygen saturation), screening is helpful to patients with breast cancer.

【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R737.9

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