發(fā)布時間：2018-01-19 13:13

  本文關鍵詞： 卵巢腫瘤 血清腫瘤標志物 彩色多普勒超聲 早期診斷　出處：《皖南醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:卵巢癌發(fā)病隱匿,缺乏早期篩查手段,大多數(shù)患者一經發(fā)現(xiàn)即是晚期,這使得卵巢癌具有高發(fā)病率、高死亡率、低生存率特點.因此尋找特異性強、靈敏度高、簡單方便、無創(chuàng)傷或創(chuàng)傷性小、可重復的檢測方法是目前國內外學者關注的焦點。本研究旨在探討卵巢癌的診斷方式,如彩色多普勒超聲、CA199、CA125、HE4、ROMA指數(shù)在卵巢腫瘤診治中的臨床意義,進而為臨床卵巢癌診斷的提供可靠參考。方法:本研究選取2015年10月-2017年1月就診于皖南醫(yī)學院附屬弋磯山醫(yī)院婦產科并接受手術治療且術后病理為卵巢腫瘤的248例患者,以及同期在本院體檢中心體檢的40例資料完整的健康者為研究對象,共288例。臨床資料經統(tǒng)計分為三組,即卵巢惡性腫瘤組、卵巢良性腫瘤組、健康對照組。收集各研究對象的既往病史、手術史、年齡、絕經狀態(tài)、彩色多普勒超聲結果(包括腫塊體積、最大直徑、境界、血供、囊實性以及有無盆腔積液)、血清CA199、CA125、HE4值、ROMA值,術后病理診斷、腫瘤的分期等。通過統(tǒng)計學方法比較各指標單一或聯(lián)合診斷的靈敏度、特異度、陽性預測值、陰性預測值等,來探討單一指標及多指標聯(lián)合應用的的臨床價值。結果:1.本研究卵巢惡性腫瘤組49例;卵巢良性腫瘤組199例;健康對照組40例,共計288例.其中卵巢惡性腫瘤患者年齡分布為16-81歲,平均年齡為:53.94±11.33歲;中位數(shù)年齡為53歲。卵巢良性疾病組年齡分布為18-75歲,平均年齡為:40.88±15.36歲;中位數(shù)年齡為41歲;健康對照組分布20-78歲,平均年齡37.82±12.28歲,中位數(shù)年齡37歲。2.血清CA125、HE4水平、ROMA指數(shù)在卵巢良惡性腫瘤及健康對照組三組間差異具有統(tǒng)計學意義(P=0.0000.001),而CA199在三組間差異無統(tǒng)計學意義(P=0.4680.05)。卵巢癌組血清CA125、HE4和ROMA值表達水平較高,且明顯高于卵巢良性腫瘤組,差異均具有顯著統(tǒng)計學意義(P=0.000,0.000,0.0000.001)。卵巢惡性腫瘤組血清CA125、HE4水平、ROMA指數(shù)與女性健康對照組比較,差異均具有顯著統(tǒng)計學差(P=0.000,0.000,0.0000.001)。卵巢良性腫瘤組血清CA125、HE4、水平、ROMA指數(shù)與女性健康對照組比較,差異無統(tǒng)計學意義(P=0.086,0.725,0.8860.05)。3.繪制血清CA125、HE4、ROMA指數(shù)的ROC曲線,計算曲線下面積(AUC),結果分別為0.857,0.823,0.846,(P=0.000,0.000,0.0000.001),但CA199的AUC面積只有0.467,(P=0.4680.05)。表明血清CA125,HE4,ROMA指數(shù)單獨應用于卵巢癌早期診斷,準確度均較高,有一定的臨床意義;但不建議單獨應用血清CA199作為卵巢癌早期診斷指標。4.彩色多普勒超聲與ROMA聯(lián)合應用的靈敏度和陰性預測值分別為93.88%和96.99%,表明對卵巢癌早期診斷臨床價值較高。結論:1.CA199,CA125,HE4,ROMA值、超聲單一應用時,ROMA靈敏度和陰性預測有明顯優(yōu)勢,HE4的特異性、陽性預測值、陰性預測值、準確度優(yōu)勢明顯.2.多指標聯(lián)合檢測時,超聲+ROMA聯(lián)合檢測時較CA199+CA125,CA125+HE4,超聲+CA125+HE4理想,可作為卵巢癌篩查的理想組合。3.血清CA125,HE4,ROMA的ROC曲線下面積(AUC)分別為0.857,0.823,0.846,(P=0.000,0.000,0.0000.001),因此血清CA125,HE4,ROMA診斷卵巢癌良惡性具有一定的臨床價值。
[Abstract]:Objective: ovarian cancer incidence of occult, lack of early screening, found that most of the patients are advanced, which makes ovarian cancer with high incidence, high mortality and low survival rate. So looking for strong specificity, high sensitivity, simple and convenient, no trauma or traumatic small, reproducible assay method is currently the focus of scholars at home and abroad. The purpose of this study is to investigate the diagnosis of ovarian cancer, such as CA199, color Doppler ultrasound, CA125, HE4, ROMA and clinical significance in the diagnosis and treatment of the ovarian tumor index for clinical diagnosis of ovarian cancer, and provide reliable reference. Methods: This study selected the October 2015 -2017 year in January in Wangnan Medical College Hospital Affiliated to the Rocky Mountain hospital of Obstetrics and Gynecology and surgery and postoperative pathology in 248 cases of ovarian cancer patients, and the same period in the hospital physical examination center of the complete data of 40 cases of healthy subjects were as the research object. 288 cases of clinical data. The statistics are divided into three groups, namely ovarian malignant tumor group, benign ovarian tumor group and healthy control group. Past medical history, collected on the study history of surgery, age, menopausal status, the results of color Doppler ultrasound (including tumor size, maximum diameter, realm, blood supply, cystic and there is no pelvic effusion), serum CA199, CA125, HE4 value, ROMA value, postoperative pathological diagnosis, staging of tumor. The sensitivity, statistical methods to compare the index of single or combined diagnostic specificity, positive predictive value, negative predictive value, to explore the clinical value of combined application of single index and multi index the results of this study: 1.. Ovarian cancer group 49 cases; 199 cases of benign ovarian tumor group and healthy control group; 40 cases, a total of 288 cases of ovarian malignant tumor. The age distribution of the patients was 16-81 years old, the average age was 53.94 + 11.33 years; the median age was 53 years. Ovarian benign disease group age 18-75 years old, the average age was 40.88 + 15.36 years; the median age was 41 years; the healthy control group distribution of 20-78 years old, mean age 37.82 + 12.28 years old, the median age was 37 years.2. serum CA125, HE4 level, ROMA index comparison difference was statistically significant between the three groups in benign and malignant group ovarian tumor and health (P=0.0000.001), and CA199 was no significant difference between the three groups (P=0.4680.05). The ovarian cancer group serum CA125, HE4 and ROMA high expression level, and was significantly higher than benign ovarian tumor group, the difference was significant statistical significance (P=0.000,0.000,0.0000.001). The ovarian cancer group serum CA125, HE4 levels the ROMA index, and the health of women compared to the control group, the difference has statistically significant difference (P=0.000,0.000,0.0000.001). The ovarian benign tumor group serum CA125, HE4 level, ROMA index and female healthy control group And there was no significant difference in serum CA125.3. (P=0.086,0.725,0.8860.05) HE4, ROC drawing, curve ROMA index, calculate the area under the curve (AUC), the results were 0.857,0.823,0.846, CA199 (P=0.000,0.000,0.0000.001), but the area is only 0.467 AUC (P=, 0.4680.05). The results indicated that serum CA125, HE4, ROMA index applied to early diagnosis ovarian cancer, the accuracy is high, has certain clinical significance; but it is not recommended to separate application of serum CA199 as the sensitivity and negative predictive index for diagnosis of.4. combined with color Doppler ultrasound and the application of ROMA in the early stage of ovarian cancer were 93.88% and 96.99%, that of higher clinical value in early diagnosis of ovarian cancer. Conclusion: 1.CA199, CA125 HE4, ROMA, ultrasound, single application, ROMA sensitivity and negative predictive advantages, specific HE4, positive predictive value, negative predictive value, accuracy of the obvious advantages of.2. multi index combined detection When combined with ultrasonic testing +ROMA compared with CA199+CA125, CA125+HE4, +CA125+HE4, ultrasound can be used as the ideal, the ideal combination of screening for ovarian cancer serum.3. CA125, HE4 ROC, the area under the ROMA curve (AUC) were 0.857,0.823,0.846 (P=0.000,0.000,0.0000.001), the serum CA125, HE4, ROMA in the diagnosis of benign and malignant ovarian cancer has some clinical value.

【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.31

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