本文選題：糖鏈抗原125　切入點：人附睪蛋白4　出處：《新疆醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討CA125、HE4及ROMA指數(shù)在早期卵巢漿液性癌診斷中的價值。方法:回顧性分析2013年1月-2016年12月就診于新疆腫瘤醫(yī)院經(jīng)病例確診的386例卵巢疾病包括早期卵巢漿液性癌組86例I期40例,II期46例)、晚期卵巢漿液性癌組105例(III期92例,IV期13)、卵巢漿液性囊腺瘤組94例和卵巢子宮內(nèi)膜異位囊組101例術前CA125和HE4血清水平及ROMA指數(shù)值,通過對各組間血清水平值、陽性率及靈敏度、特異度等指標的比較,探討單一腫瘤標記物檢測和聯(lián)合檢測在早期卵巢漿液性癌診斷中的價值。結果:(1)血清CA125值和HE4值及ROMA指數(shù)值在早期卵巢癌組與卵巢子宮內(nèi)膜異位囊腫組及卵巢漿液性囊腺瘤組中比較(均P=0.000)均P0.05,提示有助于早期卵巢漿液性癌的篩查。(2)CA125在早期卵巢癌組的陽性率(80.23%)高于ROMA指數(shù)(77.91%)和HE4(63.95%);CA125在早期卵巢癌組與卵巢子宮內(nèi)膜異位囊腫組的陽性率相比(2?=2.004,P=0.106),P0.05,提示尚不能認為CA125的陽性率有差異;HE4和ROMA指數(shù)在早期卵巢癌組與卵巢漿液性囊腺瘤組及卵巢子宮內(nèi)膜異位囊腫組的陽性率相比較(2?H E4=57.295、80.900,P=0.000、0.000;2?ROMA=91.891、67.929,P=0.000、0.000)均P0.05,差異有統(tǒng)計學意義。(3)HE4在卵巢漿液性癌組中的陽性率I期與II期、III期和IV期相比(2?=8.782、24.952、11.304,P=0.003、0.000、0.000)均P0.05,有統(tǒng)計學差異;ROMA指數(shù)在卵巢漿液性癌組中的陽性率I期與III期和IV期相比(2?=23.534、4.511,P=0.000、0.030)均P0.05,有統(tǒng)計學差異;CA125在卵巢漿液性癌組不同期別中的陽性率(2?=2.188,P=0.135)P0.05,提示CA125在卵巢癌組的陽性率與分期無明顯相關性。(4)單一腫瘤標記物檢測:HE4診斷早期卵巢癌組的特異度(95.90%)、陽性預測值(87.30%)及診斷準確度(86.12%)均高于CA125(51.28%、42.07%、60.14%)和ROMA指數(shù)(75.90%、58.77%、76.51%);ROMA指數(shù)的陰性預測值(88.62%)高于CA125(85.47%)和HE4(85.78%);R OMA指數(shù)的ROC-AUC(0.938)均大于HE4(0.908)和CA125(0.804)。(5)腫瘤標記物聯(lián)合檢測:CA125、HE4和ROMA指數(shù)三者均陽性時較一種或兩種腫瘤標記物陽性診斷早期卵巢漿液性癌的靈敏度(53.49%vs9.30%vs11.63%)、特異度(98.46%vs98.46%vs93.85%)、陽性預測值(93.88%vs25.00%vs33.33%)、陰性預測值(82.76%vs69.31%vs69.58%)、診斷準確性(84.70%vs68.68%vs67.26%)均增高。結論:(1)CA125、HE4和ROMA指數(shù)三者均陽性時更有助于早期卵巢漿液性癌的篩查、診斷。(2)HE4和ROMA指數(shù)診斷早期卵巢漿液性癌的價值優(yōu)于CA125。(3)C A125對早期漿液性卵巢癌有一定的診斷價值,更有助于臨床良性疾病的鑒別診斷;(4)HE4在卵巢癌中的陽性率隨卵巢癌期別的增加而升高。
[Abstract]:Objective: to evaluate the value of CA125HE4 and ROMA index in the diagnosis of early ovarian serous carcinoma. Methods: a retrospective analysis of 386 cases of ovarian diseases, including early ovarian plasma, diagnosed in Xinjiang tumor Hospital from January 2013 to December 2016, was conducted. In liquid carcinoma group, there were 86 cases of stage I, 40 cases of stage II, 46 cases of stage II, 105 cases of advanced ovarian serous carcinoma, 105 cases of stage III, 92 cases of stage IV, 94 cases of ovarian serous cystadenoma, and 101 cases of endometriosis of ovary. The serum levels of CA125 and HE4 and ROMA index were measured before operation. The serum level, positive rate, sensitivity and specificity of each group were compared. To evaluate the value of single tumor marker detection and combined detection in the diagnosis of early ovarian serous carcinoma. Results: 1) Serum CA125, HE4 and ROMA index in early ovarian cancer and ovarian endometriosis cyst and ovarian plasma. The positive rate of cystadenoma (P 0.000) was higher than that of ROMA index (77.91%), suggesting that the positive rate of CA125 in early ovarian cancer was higher than that in early ovarian cancer group (P < 0.05), suggesting that the positive rate of CA125 in early ovarian cancer group was higher than that in early ovarian cancer group and ovarian endometriosis cyst group (P < 0.05). The positive rate of CA125 in early ovarian cancer group was higher than that in early ovarian cancer group (77.91%) and that in early ovarian cancer group was higher than that in ovarian endometriosis cyst group (P < 0.05). It is suggested that there is no difference in the positive rate of CA125 between early ovarian cancer group and ovarian serous cystadenoma group and endometriosis cyst group. HE4 (57.295N) 80.900 (P0. 000 ~ 0. 000) 2? Roma 91.891n 67.929 (P 0.0000.000), the difference was significant (P 0.05). The positive rate of Ovarian serous carcinoma in stage I and II, stage III and stage IV were significantly higher than that in stage II, stage III and stage IV, respectively. The positive rate of P0.05in stage I was significantly higher than that in stage IV, and the positive rate in stage I was significantly higher than that in stage IV. The positive rate of Roma index in ovarian serous carcinoma group was significantly higher than that in III stage and stage IV. There was a significant difference in the positive rate of Roma index between stage I and stage IV of ovarian serous carcinoma (P 0.05, P 0.05, P 0.05, P < 0.01; P < 0.01; P < 0.05; P > 0.05; P > 0.05; P > 0.05; P > 0.05; P > 0.05; P > 0.05 respectively). The positive rate of CA125 in ovarian serous carcinoma group was 2? Conclusion: the positive rate of CA125 in ovarian cancer group has no significant correlation with the stage. 4) the specificity of the single tumor marker in the diagnosis of early ovarian cancer is 95.9090. (the positive predictive value is 87.30), and the diagnostic accuracy is 86.12).) it is higher than CA1251.281.2842.0742.0740.1440.14.) and the ROMA index is 75.9058.777.78.7777.51and the Roma index is 75.9058.777.75% higher than that of CA1251.281.2852.070.140.14) and the ROMA index is 75.9058.777.75% higher than that of CA12551.2852.07% (60.140.14). The negative predictive value (88.62) was higher than that of CA125 (85.47) and the ROC-AUC0. 938 (R OMA index of HE4) was higher than that of HE4 (0.908) and CA125 (0.804). 5) when the tumor markers were positive, the sensitivity of one or two tumor markers was higher than that of one or two tumor markers in the diagnosis of early ovarian serous carcinoma. 53.49vs9.30 vs 11.63m, the specificity of 98.46m is about 98.46vs93.85. the positive predictive value is 93.88vs25.00 and the negative predictive value is 82.76vs69.31vs69.58.The diagnostic accuracy is 84.70vs68.68vs67.26.Conclusion it is more helpful to screen early serous carcinoma when the positive ones are positive. The diagnostic value of HE4 and ROMA index in the diagnosis of early ovarian serous carcinoma is better than that of CA125.(3)C A125 in the diagnosis of early serous ovarian carcinoma. It is helpful for differential diagnosis of clinical benign diseases. The positive rate of PHE4 in ovarian cancer increases with the increase of other stages of ovarian cancer.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.31

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