本文關鍵詞：血漿D-二聚體水平與乳腺癌腋窩淋巴結轉移的相關性研究　出處：《延安大學》2015年碩士論文　論文類型：學位論文

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【摘要】：目的探討血漿D-二聚體水平與乳腺癌腋窩淋巴結轉移的關系,為預測乳腺癌腋窩淋巴結轉移狀態(tài)提供依據(jù),避免不必要的淋巴清掃術。方法1.選取2013年5月至2015年1月在延安大學附屬醫(yī)院就診的女性病例159例,其中①乳腺癌組73例,術前無相關抗腫瘤治療;②乳腺良性疾病組36例;③正常對照組50例,來源于體檢中心體檢的健康女性。收集乳腺癌組(術前一周)、乳腺良性疾病組、正常對照組三組患者肘前靜脈血,使用日本SYSMEX(希森美康)株式會社生產(chǎn)的D-二聚體測定盒測定血漿D-二聚體水平,方法為免疫比濁法。2.對所收集病例患者的一般資料(年齡、月經(jīng)狀況等)、臨床及病理資料(腫瘤大小、病理分型、是否淋巴結轉移、淋巴結轉移個數(shù)、激素受體、癌基因等)進行系統(tǒng)的整理。3.運用統(tǒng)計軟件SPSS22.0進行統(tǒng)計分析:多組間比較采用單因素方差分析,兩組間比較采用t檢驗,各組間頻數(shù)比較采用卡方檢驗。D-二聚體水平與腋窩淋巴結轉移個數(shù)之間的相關性應用Spearman相關分析。多因素分析應用非條件logistic回歸分析。P0.05為差異有統(tǒng)計學意義。結果1.乳腺良性疾病組和正常對照組的血漿D-二聚體水平明顯低于乳腺癌組,差異有統(tǒng)計學意義(P0.01)。乳腺良性疾病組的D-二聚體水平與正常對照組的D-二聚體水平相比較,差異無統(tǒng)計學意義(P0.05)。2.腋窩淋巴結轉移陽性組D-二聚體水平高于腋窩淋巴結轉移陰性組,差異有統(tǒng)計學意義(P0.01)。3.腋窩淋巴結轉移狀態(tài)與乳腺癌患者腫瘤大小、病理類型及D-二聚體水平有關。腋窩淋巴結轉移率隨著原發(fā)腫瘤直徑的增大而增加(P0.05);病理類型越差,腋窩淋巴結轉移率顯著增加(P0.01)。4.絕經(jīng)、腫瘤大小、病理類型、血漿D-二聚體水平與腋窩淋巴結轉移個數(shù)相關,其中腫瘤大小、病理類型、血漿D-二聚體水平與腋窩淋巴結轉移個數(shù)顯著相關(P0.01)。5.多因素分析顯示:原發(fā)腫瘤的病理類型、血漿D-二聚體水平是腋窩淋巴結轉移的危險因素(OR=7.464、6.470,P0.05)。6.血漿D-二聚體水平診斷乳腺癌腋窩淋巴結轉移時的ROC曲線下面積(AUC)為0.689,以0.455ug/ml為最佳診斷分界點,靈敏度為52.3%,特異度為86.2%。結論1.乳腺癌患者血漿D-二聚體水平較乳腺良性疾病患者和正常體檢者升高。2.乳腺癌血漿D-二聚體水平與腋窩淋巴結轉移狀態(tài)有關,腋窩淋巴結陽性的患者較腋窩淋巴結陰性的患者D-二聚體水平升高。3.乳腺癌腋窩淋巴結轉移個數(shù)與血漿D-二聚體水平呈正相關。4.乳腺癌腫瘤大小、病理類型、D-二聚體水平與腋窩淋巴結轉移率呈正相關,與腋窩淋巴結轉移個數(shù)亦相關。5.病理類型、血漿D-二聚體水平是乳腺癌腋窩淋巴結轉移的危險因素。6.血漿D-二聚體水平對判斷乳腺癌腋窩淋巴結轉移狀態(tài)有一定臨床價值。7.乳腺癌組織中ER、PR、Her-2的表達與腋窩淋巴結轉移無關。
[Abstract]:Objective to investigate the relationship between plasma D-dimer level and axillary lymph node metastasis in breast cancer and to provide evidence for predicting axillary lymph node metastasis in breast cancer. Methods 1. From May 2013 to January 2015, 159 female patients were selected from the affiliated Hospital of Yan'an University, including 73 cases of breast cancer. 2. There was no related antitumor therapy before operation. 2benign breast disease group: 36 cases; 3Fifty healthy women from the physical examination center in the normal control group were collected the blood of the anterior elbow vein of the breast cancer group (one week before operation, the benign breast disease group and the normal control group). The plasma levels of D- dimer were determined by using a D- dimer measuring box produced by SYSMEX (Japan) Co., Ltd. Methods the general data (age, menstrual status, etc.), clinical and pathological data (tumor size, pathological type, lymph node metastasis and number of lymph node metastasis) of the patients were collected by immunoturbidimetry. Hormone receptor, oncogene, etc. (3. Statistical software SPSS22.0 for statistical analysis: multigroup comparison using single factor analysis of variance, the comparison between the two groups using t-test. Frequency comparison among groups using chi-square test. D- dimer level and axillary lymph node metastasis number correlation using Spearman correlation analysis. Multivariate analysis using non-conditional logistic. Regression analysis. P0.05 for the difference was statistically significant. Results 1. The level of plasma D-dimer in benign breast disease group and normal control group was significantly lower than that in breast cancer group. 2. The difference was statistically significant (P 0.01). The level of D-dimer in benign breast disease group was compared with that in normal control group. The level of D-dimer in positive axillary lymph node metastasis group was higher than that in axillary lymph node metastasis negative group. The difference was statistically significant (P < 0.01). Axillary lymph node metastasis was associated with tumor size in breast cancer patients. The incidence of axillary lymph node metastasis increased with the increase of the diameter of the primary tumor (P 0.05). The worse the pathological type, the higher the rate of axillary lymph node metastasis (P 0.01). The size of menopause, tumor size, pathological type and plasma D-dimer level were correlated with the number of axillary lymph node metastasis. The tumor size, pathological type, plasma D-dimer level and the number of axillary lymph node metastasis were significantly correlated with the tumor size, pathological type and the number of axillary lymph node metastasis. Multivariate analysis showed that: the pathological type of primary tumor. Plasma D-dimer level was a risk factor for axillary lymph node metastasis. The area under ROC curve of plasma D-dimer level in diagnosis of axillary lymph node metastasis of breast cancer was 0.689. The best diagnostic boundary point was 0.455ugrml, and the sensitivity was 52.3%. The plasma D-dimer level of breast cancer patients is higher than that of benign breast disease patients and normal people. 2. Breast cancer plasma D-dimer level and axillary lymph node metastasis status. 2. Yes. The level of D-dimer in patients with positive axillary lymph nodes was higher than that in patients with negative axillary lymph nodes. There was a positive correlation between the number of axillary lymph node metastasis and plasma levels of D-dimer in breast cancer. The level of D-dimer was positively correlated with the rate of axillary lymph node metastasis and with the number of axillary lymph node metastasis. Plasma D-dimer level is a risk factor for axillary lymph node metastasis in breast cancer. 6. Plasma D-dimer level has certain clinical value in judging axillary lymph node metastasis status of breast cancer .7.ER in breast cancer tissue. . The expression of PRM Her-2 was not related to axillary lymph node metastasis.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.9

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