本文關(guān)鍵詞：彩超、CA125、HE4、ROMA在卵巢良惡性腫瘤診斷中的臨床應(yīng)用價(jià)值研究　出處：《蘭州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 彩色多普勒超聲 CA125 HE4 ROMA 卵巢腫瘤 診斷

【摘要】：目的:卵巢癌預(yù)后差,致死率高。早發(fā)現(xiàn),早診斷,早治療是目前卵巢癌的最佳治療原則。本研究旨在探討卵巢癌診斷方式:彩色多普勒超聲、CA125、HE4、ROMA在卵巢腫瘤診斷中的臨床應(yīng)用價(jià)值,進(jìn)而為臨床提供卵巢腫瘤良惡性診斷的可靠參考。方法:以甘肅省人民醫(yī)院2014.2-2015.3月期間298例因盆腔包塊在婦科接受手術(shù)治療的患者和46例本院體檢中心體檢的健康者為研究對(duì)象,收集其彩色多普勒超聲結(jié)果、血清CA125以及HE4值,并計(jì)算ROMA值,以術(shù)后病理科臨床石蠟結(jié)果作為判斷標(biāo)準(zhǔn),計(jì)算各項(xiàng)診斷方式單獨(dú)以及聯(lián)合診斷的靈敏性、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值等。結(jié)果:1.盆腔包塊患者年齡分布10~84歲,平均年齡為40.33±13.79歲,其中絕經(jīng)前246人,絕經(jīng)后52人;經(jīng)病理學(xué)確診卵巢惡性腫瘤64例(其中包括漿液性囊腺癌38例、粘液性囊腺癌13例、透明細(xì)胞癌3例、未成熟畸胎瘤3例、顆粒細(xì)胞瘤2例、支持細(xì)胞瘤1例、brener瘤1例、卵黃囊瘤1例、子宮內(nèi)膜樣癌1例、卵巢鱗狀細(xì)胞癌1例),盆腔良性疾病234例(其中包括卵巢子宮內(nèi)膜異位囊腫82例、成熟性畸胎瘤25例、囊腺瘤或纖維腺瘤40例、卵巢單純囊腫54例、輸卵管良性疾病33例)。2.卵巢惡性腫瘤組血清CA125、HE4、ROMA值明顯高于卵巢良性腫瘤組和正常健康女性組,差異據(jù)有統(tǒng)計(jì)學(xué)意義(P=0.000,0.000,0.000㩳0.05)。3.卵巢良性疾病組血清CA125、HE4、ROMA值與正常健康女性組相比,無(wú)統(tǒng)計(jì)學(xué)差異(P=0.075,0.885,0.8860.05)。4.血清CA125、HE4、ROMA(絕經(jīng)前后)、彩色多普勒超聲、彩色多普勒超聲+ROMA,各檢測(cè)方法在卵巢良惡性腫瘤的預(yù)測(cè)方面均具有誤診現(xiàn)象。5.彩色多普勒超聲具有較高的診斷特異性(91.88%)和陰性預(yù)測(cè)值(92.27%)。6.血清CA125在卵巢腫瘤診斷中陰性預(yù)測(cè)值達(dá)92.73%,突出明顯優(yōu)勢(shì)。7.血清HE4在特異性方面突出顯著優(yōu)勢(shì),為97.44%。8.對(duì)于絕經(jīng)前、后婦女,ROMA均表現(xiàn)出良好的診斷性能,但從數(shù)據(jù)的整體分布情況來(lái)看,可看出ROMA對(duì)于絕經(jīng)后婦女卵巢良惡性腫瘤診斷方面,更能體現(xiàn)優(yōu)勢(shì)。9.繪制血清CA125、HE4、ROMA的ROC曲線,計(jì)算曲線下面積(AUC),結(jié)果分別為0.857,0.823,0.846(P=0.000,0.000,0.000㩳0.05),均大于0.8,這表明單獨(dú)使用血清CA125、HE4、ROMA判斷卵巢腫瘤良惡性,同樣具有較高的準(zhǔn)確度。10.根據(jù)血清CA125、HE4的ROC曲線,尋找約登指數(shù)(r)最大值,得出血清CA125的最大r值為0.617,此時(shí)對(duì)應(yīng)的CA125 CUT-OFF值為72.66U/ml;血清HE4的最大r值為0.683,此時(shí)對(duì)應(yīng)的HE4 CUT-OFF值為64.50pmol/L。11.彩色多普勒超聲與ROMA聯(lián)合可明顯提高卵巢腫瘤的診斷靈敏性(84.38%)和陰性預(yù)測(cè)值(95.12%)。結(jié)論:1.血清CA125在鑒別卵巢腫瘤良惡性方面,建議取72.66U/mL為CUT-OFF值。2.血清HE4在鑒別卵巢腫瘤良惡性方面,建議取64.50pmol/L為CUT-OFF值。3.單獨(dú)使用血清CA125、HE4、ROMA診斷卵巢良惡性腫瘤,三者均表現(xiàn)出較高的準(zhǔn)確度;對(duì)于絕經(jīng)后婦女,ROMA更具有診斷優(yōu)勢(shì)。4.彩色多普勒超聲聯(lián)合ROMA,可將兩者優(yōu)勢(shì)結(jié)合,提高卵巢腫瘤良惡性診斷準(zhǔn)確率,其應(yīng)用價(jià)值可供臨床參考。
[Abstract]:Objective: ovarian cancer has a poor prognosis and high mortality. Early detection, early diagnosis, early treatment is the best treatment of ovarian cancer. This study aimed to investigate the diagnosis of ovarian cancer: color Doppler ultrasound, CA125, HE4, ROMA in the diagnosis of ovarian tumors in clinical application, reliable reference for the diagnosis of benign and malignant. Clinical ovarian cancer. Methods: the people's Hospital of Gansu Province during 2014.2-2015.3 months in 298 cases with pelvic surgery and 46 cases in our hospital physical examination center in gynecological health as the research object, collected the results of color Doppler ultrasound, serum CA125 and HE4 values and ROMA values were calculated as Department of pathology, clinical results of postoperative paraffin standard, the sensitivity, the calculation of the diagnosis methods alone and combined with the specificity, positive predictive value, negative predictive value. Results: 1. patients with pelvic mass and age distribution of 10~8 4 years old, the average age was 40.33 + 13.79 years, including 246 premenopausal and 52 postmenopausal; pathological diagnosis of malignant ovarian tumors in 64 cases (including 38 cases of serous cystadenocarcinoma, mucinous cystadenocarcinoma of 13 cases, 3 cases of clear cell carcinoma, 3 cases of immature teratoma, 2 cases of granular cell tumor support cell tumor in 1 cases, 1 cases, 1 cases of Brener tumor, 1 cases of yolk sac tumor, 1 cases of ovarian endometrioid carcinoma squamous cell carcinoma), pelvic benign diseases in 234 cases (including 82 cases of ovarian endometriotic cyst, 25 cases of mature teratoma, cystadenoma and 40 cases of fibroadenoma, 54 cases of ovary, simple 33 cases of cyst of fallopian tube benign disease).2. ovarian cancer group serum CA125, HE4, ROMA was significantly higher than that of benign ovarian tumor group and healthy women group, the difference has statistical significance (P=0.000,0.000,0.000? 0.05).3. ovarian benign disease group serum CA125, HE4, phase group and normal healthy women value ROMA Than, there was no significant difference in serum CA125 (P=0.075,0.885,0.8860.05).4., HE4, ROMA (menopause), color Doppler ultrasound, color Doppler ultrasound in the prediction of +ROMA, benign and malignant ovarian tumors in various detection methods have specific diagnosis misdiagnosis phenomenon of.5. color Doppler ultrasound has high negative predictive value (91.88%) and (92.27%).6. serum CA125 in diagnosis of ovarian tumors and negative predictive value of 92.73%, highlighting the obvious advantages of.7. serum HE4 outstanding advantages in specific aspects, 97.44%.8. for premenopausal women, after, ROMA showed good diagnostic performance, but the overall distribution of data, we can see that the ROMA for the diagnosis of ovarian cancer in postmenopausal women women with benign and malignant, embodies the advantages of.9. drawing HE4, serum CA125, ROC curve ROMA, calculate the area under the curve (AUC), the results were respectively 0.857,0.823,0.846 (P=0.000,0.000,0.00 0? 0.05), were more than 0.8, which shows that the use of serum CA125, HE4 alone, ROMA judgement of benign and malignant ovarian tumor, also has high accuracy.10. according to the serum CA125, ROC curve HE4, looking for the maximum Youden index (R), the largest R that serum CA125 value is 0.617, which corresponds to CA125 the CUT-OFF value is 72.66U/ml; the maximum r serum HE4 value is 0.683, the corresponding HE4 CUT-OFF 64.50pmol/L.11. value of color Doppler ultrasound combined with ROMA can significantly improve the diagnostic sensitivity of ovarian tumors (84.38%) and negative predictive value (95.12%). Conclusion: 1. the serum CA125 in the differential diagnosis of benign and malignant ovarian tumor, suggest taking 72.66U/mL the CUT-OFF value of serum.2. HE4 in differentiating benign and malignant ovarian tumor, suggest taking 64.50pmol/L CUT-OFF value of single.3. serum CA125, HE4, ROMA in the diagnosis of benign and malignant ovarian tumors, three showed a high degree of accuracy; for postmenopausal women Women, ROMA is more diagnostic advantage..4. color Doppler ultrasound combined with ROMA can combine the advantages of both, improve the accuracy of diagnosis of benign and malignant ovarian tumors, and its application value can be used for clinical reference.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R737.31

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