本文選題：乳腺癌 + 腫瘤異常蛋白　； 參考：《新鄉(xiāng)醫(yī)學院》2017年碩士論文

【摘要】：背景乳腺癌是女性最常見的惡性腫瘤,及時明確的診斷對乳腺癌患者生存和生活質量有著非常重要的影響,所以迫切需要準確的診斷指標。最常用的血清腫瘤標志物是糖類抗原153(cancer antigen 153;CA153)、癌胚抗原(carcinoembryonic antigen;CEA)、糖類抗原125(Carbohydrate antigen 125;CA125),然而它們的靈敏度和特異度相對較低。盡管如此,它們在監(jiān)測惡性腫瘤療效、復發(fā)方面有特別的價值,乳腺放射等檢查所不能替代。腫瘤標志物有快速、無創(chuàng)、簡單的特點,在乳腺惡性腫瘤診斷和治療起著越來越重要的作用。因此,如何利用分子生物學技術發(fā)現(xiàn)乳腺癌診斷率高的腫瘤標志物己成為目前臨床的研究方向之一。目的通過檢測乳腺癌患者血清腫瘤標志物腫瘤異常蛋白(Tumor abnormal protein;TAP)、CA153、CA125、CEA的表達水平,探討四個指標聯(lián)合檢測在乳腺癌患者中的臨床意義。方法選取2015年10月至2016年10月在新鄉(xiāng)市中心醫(yī)院收治的113例乳腺癌患者作為觀察組,另選取我院同期收治的乳腺良性病變者33例及健康體檢者57例作為對照組。應用電化學發(fā)光法檢測CA153、CEA和CA125血清水平,應用TAP檢測系統(tǒng)檢測TAP水平。選用SPSS 19.0統(tǒng)計軟件進行全部數據的統(tǒng)計學處理,計量資料測定結果以均數±標準差表示,組間比較采用t檢驗,計數資料及率的比較選用χ2檢驗。并應用靈敏度、特異度及正確率,評價本實驗所納入指標單獨及聯(lián)合診斷乳腺癌的效能。結果血清TAP、CA153、CA125及CEA均可作為乳腺癌診斷的參考指標,乳腺癌組分別與乳腺良性疾病對照組和健康對照組相比,血清TAP、CA153、CA125及CEA表達水平均有顯著性差異(P0.05)。TAP、CA153、CA125和CEA在乳腺癌診斷中的正確率分別是61.58%、61.08%、52.71%、51.23%,靈敏度分別是34.51%、32.74%、21.24%、16.81%;特異度分別是95.56%、96.67%、90.00%、94.44%。單項指標檢測中,TAP正確率最高,其值為61.58%,TAP靈敏度最高,其值為34.51%,CA153特異度最高,其值為96.67%。兩項指標聯(lián)合,TAP、CA153聯(lián)合在六種組合中為較佳組合,正確率、靈敏度、特異度分別是68.47%、49.56%、92.22%。三個指標聯(lián)合中,其中TAP、CA153、CEA三者聯(lián)合在四種組合中的正確率、靈敏度、特異度均為最高,分別是68.47%、53.98%、86.67%。四個指標共同聯(lián)合檢測診斷性試驗的靈敏度為:58.41%,特異度為76.67%,正確率為66.50%。將較佳的兩項、三項、四項聯(lián)合進行比較,根據擇優(yōu)法及實用性原則,TAP聯(lián)合CA153為本研究乳腺癌診斷的最佳組合。治療后(手術及化療)乳腺癌患者的CA153、CA125、CEA的血清水平較治療前有明顯的降低,兩組比較差異有統(tǒng)計學意義(P0.05),TAP在治療前后差異不明顯(P0.05)。TAP在1月后再次復查時和治療前相比結果下降明顯,差異有統(tǒng)計學意義(P0.05)。單因素分析顯示,血清TAP與腫瘤大小、淋巴結轉移狀態(tài)以及組織病理學分期不相關(P0.05)。結論通過血清TAP、CA153、CA125和CEA四個指標的不同聯(lián)合,可為乳腺癌輔助診斷提供幫助;在不同的指標組合中,TAP、CA153聯(lián)合檢測可作為乳腺癌輔助診斷的最優(yōu)組合。
[Abstract]:Background breast cancer is the most common malignant tumor in women. Timely and clear diagnosis has a very important impact on the survival and quality of life of breast cancer patients. Therefore, accurate diagnostic indicators are urgently needed. The most commonly used serum tumor markers are carbohydrate antigen 153 (cancer antigen 153; CA153), carcinoembryonic antigen (carcinoembryonic antigen; CEA). Carbohydrate antigens 125 (Carbohydrate antigen 125; CA125), however, are relatively low in sensitivity and specificity. Nevertheless, they are of special value in monitoring the curative effect of malignant tumors and in the recurrence of breast radiology. The tumor markers have rapid, noninvasive, simple characteristics, and the diagnosis and treatment of breast cancer. It is becoming more and more important. Therefore, how to use molecular biology technology to detect tumor markers with high diagnostic rate of breast cancer has become one of the current clinical research directions. Objective to explore the expression level of Tumor abnormal protein (TAP), CA153, CA125 and CEA by detecting the serum tumor markers of breast cancer patients, four Methods 113 cases of breast cancer treated in Xinxiang Central Hospital from October 2015 to October 2016 were selected as observation group. 33 cases of benign breast lesions in our hospital and 57 cases of healthy persons were selected as control group. CA153, C were detected by electrochemiluminescence. The serum level of EA and CA125 was used to detect the level of TAP by TAP detection system. The statistical processing of all data was processed with SPSS 19 statistical software. The results of measurement data were expressed with mean standard deviation. T test was used for comparison between groups. The comparison of count data and rate was selected by the x 2 test. Results the serum TAP, CA153, CA125 and CEA could be used as a reference index for the diagnosis of breast cancer. Compared with the benign breast disease control group and the healthy control group, the serum TAP, CA153, CA125 and CEA expressed in the breast cancer group were significantly different (P0.05).TAP, CA153, CA125, and CEA. The correct rate in the diagnosis of breast cancer was 61.58%, 61.08%, 52.71%, 51.23%, and the sensitivity was 34.51%, 32.74%, 21.24%, 16.81% respectively. The specificity was 95.56%, 96.67%, 90%, and the 94.44%. was the highest, its value was 61.58%, the TAP sensitivity was the highest, and the value of CA153 was the highest, and its value was 96.67%. two finger. The combination of standard, TAP, and CA153 is a better combination of the six combinations. The accuracy, sensitivity, and specificity of the combination are 68.47%, 49.56%, and 92.22%., respectively, among which TAP, CA153, and CEA three are combined in the four combinations with the highest accuracy, sensitivity, and specificity, which are 68.47%, 53.98%, and four 86.67%., respectively. The sensitivity of the test was 58.41%, the specificity was 76.67%, the correct rate was 66.50%., the better two, three and four combined. According to the optimal method and the practical principle, TAP combined with CA153 was the best combination of the diagnosis of breast cancer in this study. The serum level of CA153, CA125, CEA in the patients with breast cancer after treatment (operation and chemotherapy) was compared with the treatment. The difference between the two groups was statistically significant (P0.05), and the difference of TAP before and after treatment was not obvious (P0.05), and the difference was significant (P0.05). The single factor analysis showed that serum TAP and tumor size, lymph node metastasis state and histopathology staging were found. No correlation (P0.05). Conclusion the combination of four indicators of serum TAP, CA153, CA125 and CEA can help diagnosis of breast cancer. In different combination of index, TAP, CA153 combined detection can be the best combination of breast cancer diagnosis.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

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