女性生殖道肿瘤患者血浆D二聚体水平检测的评价

Evaluation of Plasma D-dimer Levels in Female Patients with Reproductive System Tumors

目的 评价女性生殖道肿瘤（包括良、恶性宫颈、子宫和卵巢肿瘤）患者血浆D二聚体（D-D）水平及其诊断和鉴别诊断的价值。方法 选择女性生殖道肿瘤患者211例（恶性肿瘤患者125例,良性肿瘤患者86例）作为研究对象,以同期30例健康妇女作为对照,检测患者治疗前和健康对照血浆D-D水平。结果 宫颈癌（F=73.122,P〈0.001）、子宫内膜癌（F=47.892,P〈0.001）和卵巢癌（F=42.885,P〈0.001）患者D-D水平与对照组间均存在统计学差异。Spearman等级相关分析显示宫项癌（r=0.923,P〈0.001）、子宫内膜癌（r=0.856,P〈0.001）和卵巢癌（r=0.928,P〈0.001）TNM分期与D-D水平间明显的相关性。所观察3种肿瘤在自身组织中均有较高的诊断性能,ROC分析显示曲线下的面积宫颈癌、子宫内膜癌和卵巢癌分别是0.983（95%CI：0.930～0.999）、0.921（0.853～0.964）和0.946（0.884～0.981）,诊断正确率依次是0.706（0.512～0.772）0.861、（0.736～0.917）和0.790（0.658～0.877）;但3种肿瘤相互鉴别诊断的诊断性能较差,宫颈癌、子宫内膜癌和卵巢癌鉴别诊断曲线下的面积分别是0.753（0.668～0.826）、0.632（0.541～0.717）和0.661（0.570～0.743）;诊断正确指数分析是0.423（0.259～0.545）、0.313（0.143～0.419）和0.306（0.170～0.439）。结论 女性生殖道肿瘤（宫颈、子宫和卵巢肿瘤）血浆D-D水平在恶性肿瘤患者高于良性肿瘤患者高于健康对照人群。随肿瘤TNM分期增加,D-D水平随之增加。血浆D-D水平在所观察的女性生殖道疾病各组织内对肿瘤的诊断性能较高,但肿瘤相互间鉴别诊断的性能较低。

Objective To determine plasma D-dimer（D-D） levels and evaluate its the diagnostic and differential diagnostic effects in patients with female reproductive tract tumors Methods 211 female patients with reproductive tract tumors （malignant tumor125 cases, benign tumor 86 cases ）as experimental group, meanwhile ,30 healthy volunteers as control group. The levels of plasma D- D in experimental group before treatment and control group were detected. Results The levels of plasma D-D were increased in patients with cervical cancer（ F = 73. 122, P 〈 0. 001 ）, uterine cancer（ F = 47. 892, P 〈 0. 001 ）, and ovarian cancer（ F = 42. 885 ,P 〈 0. 001 ） , respectively, compared with in the control group. Spearman rank analysis showed there was a good correlation between the levels of plasma D- D and TNM stage in cervical cancer （ r = 0. 923, P 〈 0. 001 ） ,uterine cancer（ r = 0. 856, P 〈 0. 001 ） and ovarian cancer（ r = 0. 928, P 〈 0. 001 ）. Of the observed three kinds of tumors, the levels of plasma D- D had a good diagnostic performance ： the area under the ROC curve （ AUC ） was 0. 983 （95 % CI ： 0. 930～ 0. 999 ）, 0. 921 （ 0. 853～ 0. 964 ）, 0. 946 （ 0. 884 ～ 0.981 ）, the di- agnostic accuracy was 0. 706 （0. 512 ～ 0. 772 ）0. 861, （0. 736 ～ 0. 917 ） , 0. 790 （0. 658 ～ 0. 877 ） in cervical cancer,uterine cancer and ovarian cancer, respectively. However, there is a poor differential diagnostic per-formance among 3 malignant tumors：the AUC was 0. 753 （0. 668 ～ 0. 826 ） ,0. 632 （0. 541 ～0. 717） ,0. 661 （0. 570～ 0. 743 ）, the diagnostic accuracy was 0. 423 （ 0. 259 ～ 0. 545 ）, 0. 313 （ 0. 143 ～ 0. 419 ）, 0. 306 （0. 170 ～0. 439） ,in cervical cancer,uterine cancer and ovarian cancer,respectively. Conclusion The level of plasma D-D in female patients with reproductive system tumors （including cervical, uterine or ovarian cancer tumors） in malignant patients was higher than in benign patients than in healthy volunteers. By increasing the TNM stage of reproductive tract malignant tumors ,the levels of plasma D-D were increased. The levels of plas- ma D-D had a good diagnostic performance between the same female reproductive tumors, but it had a poor differential diagnostic performance among different tumor female reoroductive malignant tumors.