本文選題：腹水sHLA-G + 惡性腹水�。� 參考：《西安醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討人可溶性白細(xì)胞抗原G(Soluble human leukocyte antigen-G,s HLA-G)在良惡性腹水鑒別診斷中的價(jià)值。方法:納入2016年1月至2016年12月于西安醫(yī)學(xué)院第一附屬醫(yī)院住院的腹水患者94例,根據(jù)最終診斷分為惡性腹水組(64例)和良性腹水組(30例)。收集腹水樣本及對(duì)應(yīng)患者同一時(shí)段的血漿樣本,ELISA方法檢測腹水和血漿中的s HLA-G含量,采用ROC曲線評(píng)估腹水s HLA-G檢測在良惡性腹水鑒別診斷中的價(jià)值,并與傳統(tǒng)腫瘤標(biāo)志物及腹水細(xì)胞病理學(xué)檢查進(jìn)行對(duì)比分析。結(jié)果:1.惡性腹水組的腹水s HLA-G含量顯著高于良性腹水組[(20.718±3.215)ug/L vs(12.467±3.678)μg/L],差異具有極顯著性(t=7.425,P0.001);血漿s HLA-G含量亦顯著高于良性腹水組[(19.530±4.355)μg/L vs(13.326±3.192)μg/L],差異具有極顯著性(t=4.546,P0.001);兩組內(nèi)腹水和血漿s HLA-G含量配對(duì)比較,差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。肝硬化腹水組與結(jié)核性腹水組比較,腹水和血漿s HLA-G含量差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。2.惡性腹水組的腹水CEA、CA19-9含量明顯高于良性腹水組(P0.05);而腹水AFP、CA125在兩組之間的含量差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.ROC曲線分析結(jié)果顯示:當(dāng)腹水s HLA-G的界值為19.60μg/L時(shí),其預(yù)測診斷惡性腹水的靈敏度為87.5%(95%CI:71.0-96.5%),特異度為100%(95%CI:88.4-100%),ROC曲線下面積為0.957(95%CI:0.872-0.992),與傳統(tǒng)腫瘤標(biāo)志物腹水CEA(68.75%,83.33%,0.810)及腹水CA19-9(65.63%,70%,0.710)比較,差異均具有統(tǒng)計(jì)學(xué)意義(P值均0.05);靈敏度與腹水細(xì)胞病理學(xué)比較(50%),差異具有統(tǒng)計(jì)學(xué)意義(P0.05),特異度均為100%。4.s HLA-G與CEA、CA19-9在惡性腹水中的含量不具相關(guān)性(P0.05);且與患者的年齡、性別亦無明顯關(guān)系,但在不同腫瘤類型的腹水中,s HLA-G含量差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5.在32例腹水細(xì)胞病理學(xué)陰性但活檢陽性的惡性腹水中,腹水s HLA-G的陽性檢出率為75%,與腹水CEA(31.25%)及CA19-9(6.25%)比較,差異均具有統(tǒng)計(jì)學(xué)意義(P值均0.01)。結(jié)論:1.腹水sHLA-G檢測對(duì)于良惡性腹水的鑒別具有較好的診斷效能,可能是預(yù)測診斷惡性腹水的獨(dú)立指標(biāo)。2.腹水s HLA-G檢測有助于篩查細(xì)胞學(xué)檢查陰性的惡性腹水,可以作為腹水細(xì)胞學(xué)輔助檢查的一個(gè)重要生物學(xué)標(biāo)志物。
[Abstract]:Objective: to investigate the value of human soluble leukocyte antigen (G(Soluble human leukocyte antigen-GG) in differential diagnosis of benign and malignant ascites. Methods: from January 2016 to December 2016, 94 patients with ascites were divided into malignant ascites group (n = 64) and benign ascites group (n = 30). The levels of s HLA-G in ascites and plasma samples were detected by Elisa in the same period of time, and the value of s HLA-G detection in the differential diagnosis of benign and malignant ascites was evaluated by ROC curve. The results were compared with traditional tumor markers and ascites cytopathology. The result is 1: 1. The level of s HLA-G in malignant ascites was significantly higher than that in benign ascites [20. 718 鹵3.215)ug/L vs(12.467 鹵3. 678 渭 g / L], the difference was significant (P < 0. 001), and the plasma s HLA-G content was significantly higher than that in benign ascites [19. 530 鹵4. 355 渭 g / L vs(13.326 鹵3. 192 渭 g / L]. The difference was not statistically significant (P = 0.05). Compared with tuberculous ascites, there was no significant difference in the levels of s HLA-G in ascites and plasma between cirrhotic ascites group and tuberculous ascites group. The levels of CA19-9 in ascites in malignant ascites were significantly higher than those in benign ascites, but there was no significant difference between the two groups in the content of ascitic fluid AFPnCA125. 3. The results of ROC curve analysis showed that when the limit of ascitic fluid s HLA-G was 19.60 渭 g / L, there was no significant difference between the two groups. Its sensitivity in predicting and diagnosing malignant ascites is 87.5%, and the specificity is 100%, 95% CI 88.4-100. The area under the ROC curve is 0.957 ~ 95CI: 0.872-0.992, which is compared with the traditional tumor marker CEA 68.75 (83.333.330.10) and ascites CA19-9 (65.63) and ascitic fluid CA19-9 (65.63) and ascitic fluid (CA19-9 / 65.63) and the area under the ROC curve is 0.957 ~ 95CI: 0.872-0.992n, compared with the traditional tumor marker CEA (68.75 83.330.10) and ascites CA19-9 and 65.63%. The difference was statistically significant (P < 0.05), the sensitivity was significantly higher than that of ascites cytopathology, the difference was statistically significant (P 0.05), the specificity was 100. 4. S HLA-G and CEA CA19-9 in malignant ascites, and there was no correlation between the sensitivity and the age of the patients. There was no significant relationship between sex and sex, but there was significant difference in the content of HLA-G in ascites of different tumor types (P 0.05. 5). In 32 cases of malignant ascites with negative ascites cytopathology but positive biopsy, the positive rate of ascitic fluid s HLA-G was 75, which was higher than that of ascites CEA 31.25 and CA19-9 6.25). The difference was statistically significant (P < 0.01). Conclusion 1. The detection of sHLA-G in ascites has good diagnostic efficacy for the differential diagnosis of benign and malignant ascites, and may be an independent index of predicting malignant ascites. The detection of ascitic fluid s HLA-G is helpful for screening malignant ascites with negative cytology and can be used as an important biomarker for ascitic cytology auxiliary examination.
【學(xué)位授予單位】：西安醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R730.4

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