【摘要】：目的:探討腫瘤標(biāo)志物聯(lián)合D-二聚體診斷HCC合并PVTT的臨床意義。方法:本研究的對象是2015年1月至2016年12月在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院住院就診,術(shù)前檢查或者術(shù)后病理診斷為HCC無或合并PVTT的71名患者,對其臨床資料進(jìn)行了回顧性分析。使用SPSS軟件進(jìn)行統(tǒng)計(jì)分析。用卡方檢驗(yàn)對各組數(shù)據(jù)進(jìn)行比較,使用ROC曲線來分析敏感度、特異度、確定診斷PVTT的cut-off值。P0.05可認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果:本研究收集了診斷HCC是否合并PVTT可能具有臨床意義的4個因素,分別如下所述。AFP的ROC曲線面積圖為0.827,將AFP分為陽性組(≥725.85 μg/L)組和陰性組(725.85μg/L)組,敏感度為0.773,特異度為0.893,兩組數(shù)據(jù)有顯著性差異(P=0.000);D-二聚體的ROC面積圖為0.833,將D-二聚體分為陽性組(≥535.50μg/L)和陰性組(535.50μg/L),敏感度為0.933,特異度為0.750,兩組數(shù)據(jù)有顯著性差異(P=0.000);CA125的ROC曲線面積圖為0.769,將CA125分為陽性組(20.90 U/mL)和陰性組(20.90 U/mL),敏感度為0.667,特異度為0.821,兩組數(shù)據(jù)有顯著性差異(P=0.001);CA19-9的ROC面積圖為0.713,將CA19-9陽性組(≥8.25 U/mL)和陰性組(8.25 U/mL),敏感度為0.800,特異度為0.589,兩組數(shù)據(jù)有顯著性差異(P=0.012)。AFP聯(lián)合D-二聚體的串聯(lián)試驗(yàn)(AFP≥725.85 μg/L且D-二聚體≥535.50μg/L為陽性,其余為陰性):得出敏感度為0.733,特異度為0.982,卡方檢驗(yàn)提示兩組數(shù)據(jù)有顯著性差異(P=0.000),并聯(lián)試驗(yàn)(AFP≥725.85μg/L或D-二聚體≥535.50μg/L為陽性,其余為陰性):得出敏感度為0.933,特異度為0.661,卡方檢驗(yàn)提示兩組數(shù)據(jù)有顯著性差異(P=0.000);AFP聯(lián)合CA125的串聯(lián)試驗(yàn)(AFP≥725.85μg/L且CA125≥20.90U/mL為陽性,其余為陰性):得出敏感度為0.600,特異度為0.982,卡方檢驗(yàn)提示兩組數(shù)據(jù)有顯著性差異(P=0.000),并聯(lián)試驗(yàn)(AFP≥725.85μg/L或CA125≥20.90U/mL為陽性,其余為陰性):得出敏感度為0.800,特異度為0.732,卡方檢驗(yàn)提示兩組數(shù)據(jù)有顯著性差異(P=0.001);CA125聯(lián)合D-二聚體的串聯(lián)試驗(yàn)(CA125≥20.90 U/mL且D-二聚體≥535.50μg/L為陽性,其余為陰性):得出敏感度為0.667,特異度為0.875,卡方檢驗(yàn)提示兩組數(shù)據(jù)有顯著性差異(P=0.000),并聯(lián)試驗(yàn)(CA125≥20.90 U/mL或D-二聚體≥535.50 μg/L為陽性,其余為陰性):得出敏感度為0.933,特異度為0.696,卡方檢驗(yàn)提示兩組數(shù)據(jù)有顯著性差異(P=0.000)。結(jié)論:1.AFP、CA125、CA19-9、D-二聚體對獨(dú)立診斷是否合并PVTT的HCC患者具有臨床意義,其中AFP、CA125、D-二聚體具有較高診斷價值。2.腫瘤標(biāo)志物聯(lián)合D-二聚體對聯(lián)合診斷是否合并PVTT的HCC患者具有臨床意義,聯(lián)合檢測腫瘤標(biāo)志物及D-二聚體可提高PVTT的早期發(fā)現(xiàn)率。
[Abstract]:Objective: to investigate the clinical significance of tumor markers combined with D-dimer in diagnosis of HCC with PVTT. Methods: from January 2015 to December 2016, 71 patients with HCC without or with PVTT were admitted to the first affiliated Hospital of Zhejiang University Medical College. The clinical data were analyzed retrospectively. SPSS software was used for statistical analysis. The data of each group were compared by chi-square test, the sensitivity and specificity were analyzed by ROC curve, and the cut-off value of diagnosis was determined. P05 could be regarded as statistically significant. Results: in this study, we collected four factors that might be of clinical significance in the diagnosis of HCC with PVTT. The ROC curve area map of AFP was 0.827. AFP was divided into positive group (鈮，

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