本文關(guān)鍵詞： 肝癌臨床診斷 cfDNA 多腫瘤標(biāo)志物 ROC曲線 Logistic回歸　出處：《浙江理工大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：肝癌是一種高發(fā)病率和高死亡率的惡性腫瘤。在全球范圍內(nèi),每年都有無數(shù)的人死于肝癌。其中,中國是肝癌高發(fā)病率的國家,占據(jù)了全球約一半的發(fā)病人數(shù)。而中國的肝癌患者普遍有著慢性乙型肝炎的病史,且大多數(shù)經(jīng)歷了肝硬化的過程。因此,在中國患有慢性乙型肝炎的患者以及肝硬化的患者將成為肝癌的高發(fā)人群,也是肝癌臨床早期診斷的重點(diǎn)人群。然而,肝癌在臨床早期隱匿性高,診斷困難,這使得很多的肝癌患者錯(cuò)過了最佳的治療時(shí)期。目前,放射治療、化學(xué)藥物治療以及外科切除手術(shù)是治療肝癌的主要方法。但對(duì)于中晚期的肝癌患者來說,這些方法并不能達(dá)到治愈肝癌的目的。因此,提高肝癌臨床診斷技術(shù)就顯現(xiàn)出了非常重要的意義。本文采用試劑盒的方法分離和純化了31名原發(fā)性肝癌患者外周血中的cfDNA,并且利用熒光定量PCR技術(shù)測(cè)定cfDNA的濃度。基于cfDNA的濃度初步評(píng)估其在肝癌臨床診斷中的價(jià)值。之后收集了這31名原發(fā)性肝癌患者的臨床診斷數(shù)據(jù),包括了CT檢測(cè)、MRI檢測(cè)、US檢測(cè)三項(xiàng)影像學(xué)檢測(cè)信息以及性別、年齡、多腫瘤標(biāo)志物檢測(cè)等重要的信息。利用Excel、SPSS分析軟件對(duì)原發(fā)性肝癌患者的臨床數(shù)據(jù)進(jìn)行整理和統(tǒng)計(jì)分析。熒光定量PCR的結(jié)果顯示,31名原發(fā)性肝癌患者cfDNA濃度的平均值為121.58 ng/mL,中值為36.2 ng/mL,這一結(jié)果比較符合相關(guān)研究。臨床數(shù)據(jù)分析結(jié)果顯示,31名原發(fā)性肝癌患者中以男性居多。而從年齡分布上看,年齡在40至60歲的患者居多,該年齡段是肝癌高發(fā)的年齡段。40歲以下和60歲以上的患病人數(shù)相對(duì)較少。肝炎肝硬化情況則為僅1名患者(占3.23%)為非慢性乙型肝炎的患者,其余30名患者(96.77%)均伴有慢性乙型肝炎。25名(80.65%)患者為肝硬化患者,6名(19.35%)患者為非肝硬化患者。該數(shù)據(jù)表明中國的肝癌患者基本患有慢性乙型肝炎,且多數(shù)經(jīng)歷肝硬化過程。根據(jù)肝癌臨床診斷中血清標(biāo)志物的正常范圍值評(píng)估各項(xiàng)指標(biāo)的臨床診斷率。結(jié)果顯示,在血清標(biāo)志物中以AFP的診斷率最高,其次為CA19-9和CA242,其余的指標(biāo)較低。而AFP的腫瘤特異性又低于CA19-9和CA242。本文進(jìn)一步利用ROC曲線分析AFP、CA242、CA19-9、CA125、CEA、CYFRA21-1、NSE這七項(xiàng)指標(biāo)在肝癌臨床中的診斷價(jià)值。結(jié)果同樣得到,AFP的診斷率最高,其次為CA19-9和CA242,其余的指標(biāo)較低的結(jié)論。并且利用Logistic回歸模型綜合了AFP、CA242、CA19-9和CEA這四項(xiàng)指標(biāo)對(duì)肝癌臨床診斷價(jià)值進(jìn)行評(píng)估。結(jié)果表明,綜合這四項(xiàng)指標(biāo)后臨床診斷率將高于任何單獨(dú)一項(xiàng)的臨床診斷率。
[Abstract]:Liver cancer is a malignant tumor with high morbidity and mortality. Worldwide, millions of people die of liver cancer every year. Among them, China is a country with high incidence of liver cancer. It accounts for about half of the total number of people with liver cancer in the world. Chinese patients with liver cancer generally have a history of chronic hepatitis B, and most of them have gone through the process of cirrhosis. In China, patients with chronic hepatitis B and patients with liver cirrhosis will become a high incidence of liver cancer, and will also be the focus of early diagnosis of liver cancer. However, liver cancer is highly occult in the early clinical stage and difficult to diagnose. This leaves many patients with liver cancer missing out on the best treatment period. Currently, radiotherapy, chemotherapy and surgical resection are the main treatments for liver cancer. But for patients with advanced liver cancer, These methods cannot cure liver cancer. It is very important to improve the technique of clinical diagnosis of liver cancer. In this paper, the cfDNAs in peripheral blood of 31 patients with primary liver cancer were isolated and purified by the method of kit, and the concentration of cfDNA was determined by fluorescence quantitative PCR. The value of cfDNA in the clinical diagnosis of hepatocellular carcinoma was preliminarily evaluated based on the concentration of cfDNA. The clinical diagnostic data of the 31 patients with primary liver cancer were collected. Including CT, MRI, MRI, US, three items of imaging information, sex, age, The clinical data of patients with primary liver cancer were collected and statistically analyzed by using Excel SPSS software. The results of fluorescence quantitative PCR showed the average concentration of cfDNA in 31 patients with primary liver cancer. The value was 121.58 ng / mL, and the median value was 36.2 ng / mL, which was consistent with the relevant study. Clinical data analysis showed that the majority of 31 patients with primary liver cancer were male, and in terms of age distribution, The majority of patients aged 40 to 60 had a high incidence of liver cancer. The number of patients under 40 years of age and over 60 years of age was relatively low. The incidence of cirrhosis was only one patient (3.23%) with non-chronic hepatitis B. The remaining 30 patients with chronic hepatitis B (80.65) and the patients with cirrhosis (6 / 19.35) are non-cirrhosis patients. The data show that Chinese patients with liver cancer are basically suffering from chronic hepatitis B. According to the normal range of serum markers in the clinical diagnosis of liver cancer, the clinical diagnosis rate of each index was evaluated. The results showed that the diagnostic rate of AFP was the highest among the serum markers. The other indexes were CA19-9 and CA242, and the tumor specificity of AFP was lower than that of CA19-9 and CA242.In this paper, we further use ROC curve to analyze the diagnostic value of CA19-9 CA242CA19-9 and CA125CEACAFRA21-1NSE in the clinical diagnosis of hepatocellular carcinoma. Results the diagnostic rate of AFP was also the highest. Secondly, CA19-9 and CA242, and the conclusion that the other indexes were lower. The four indexes AFPCA242CA19-9 and CEA were synthesized by using Logistic regression model to evaluate the clinical diagnosis value of HCC, and the results showed that there was no significant difference between AFPCA242CA19-9 and CA242CA19-9 in clinical diagnosis of HCC. The clinical diagnosis rate after these four indexes is higher than that of any single item.
【學(xué)位授予單位】：浙江理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
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本文編號(hào)：1491568