阴道彩色多普勒血流显像血流参数对卵巢肿瘤良恶性鉴别诊断价值研究

Diagnostic and disease progression appraisal value of ovarian cancer patients by transvaginal color Doppler ultrasound

目的探讨阴道彩色多普勒血流显像血流参数对卵巢肿瘤良恶性鉴别诊断的价值。方法选取成都市妇女儿童中心医院自2012年1月至2018年1月收治的120例卵巢肿瘤患者为研究对象。根据病理检查结果,将患者分入卵巢良性肿瘤组(A组,n=60)与卵巢癌组(B组,n=60);再根据肿瘤病理分期,将B组患者分入Ⅰ期组(n=15)、Ⅱ期组(n=17)、Ⅲ期组(n=16)及Ⅳ期组(n=12)。比较A、B两组超声评分,A、B两组及B组中Ⅰ、Ⅱ、Ⅲ、Ⅳ期组患者的阴道彩色多普勒血流显像血流参数;同时分析阴道彩色多普勒血流显像血流参数与肿瘤血管新生、疾病进展之间的关系。结果 B组患者超声评分为(7. 6±2. 2)分,显著高于A组的(3. 1±1. 3)分,差异有统计学意义(P <0. 05)。B组中,Ⅰ、Ⅱ、Ⅲ、Ⅳ期组患者的超声评分分别为(6. 1±1. 5)分、(7. 2±2. 0)分、(8. 4±2. 5)分、(9. 4±2. 9)分,即随着病理分期的升高,超声评分也随之升高,两两比较,差异均有统计学意义(P <0. 05)。B组患者微血管密度、促血管生成素-2阳性表达率、血管内皮生长因子水平均高于A组,而人第10号染色体缺失磷酸酶(PTEN)、人线粒体融合素-2、肿瘤抑癌基因7-L水平均低于A组,差异有统计学意义(P <0. 05)。B组中,随着病理分期的升高,患者微血管密度、促血管生成素-2阳性表达率、血管内皮生长因子水平逐渐升高,而PTEN、人线粒体融合素-2、肿瘤抑癌基因7-L水平逐渐降低,两两比较,差异均有统计学意义(P <0. 05)。微血管密度、促血管生成素-2阳性表达率、血管内皮生长因子水平均与搏动指数、动脉血管阻力指数呈负相关,与舒张末期流速、峰值流速、平均流速呈正相关(P <0. 05); PTEN、人线粒体融合素-2、肿瘤抑癌基因7-L水平均与搏动指数、动脉血管阻力指数呈正相关,与舒张末期流速、峰值流速、平均流速呈负相关(P <0. 05)。结论阴道彩色多普勒血流显像血流参数可作为鉴别诊断卵巢肿瘤良恶性的重要敏感指标,其与肿瘤血管新生、疾病进展密切相关。

Objective To investigate the diagnostic and disease progression appraisal value of ovarian cancer patients by transvaginal color Doppler ultrasound. Methods A retrospective study was performed on 120 cases of patients with ovarian tumors who were admitted from January 2012 to January 2018. According to the pathological examination results,the patients were divided into the benign ovarian tumor group( Group A,n = 60) and the ovarian cancer group( Group B,n = 60). Once more according to tumor pathologic stage,patients of Group B were subdivided into the Ⅰ period group( n = 15),Ⅱ period group( n = 17),Ⅲ period group( n = 16) andⅣ group( n = 12). To compare the ultrasonic score in both groups,color doppler flow imaging in vaginal blood flow parameters in both groups,and Ⅰ,Ⅱ,Ⅲ,Ⅳ periods in Group B. The relationship between blood flow parameters and tumor angiogenesis and disease progression was also analyzed. Results The ultrasound score of Group B was( 7. 6 ± 2. 2),significantly higher than that of Group A( 3. 1 ± 1. 3),and the difference was statistically significant( P < 0. 05). In Group B,Ⅰ,Ⅱ,Ⅲ,Ⅳ period groups of patients with ultrasonic score was( 6. 1 ± 1. 5),( 7. 2 ± 2. 0),( 8. 4 ± 2. 5),( 9. 4 ± 2. 9) points,respectively,namely with the increase of pathological staging,ultrasonic score also will rise,pairwise comparison had statistical significance( P < 0. 05). The microvascular density,the positive expression rate of angiopoietin-2,and the level of vascular endothelial growth factor in Group B were all higher than those in Group A,while the levels of human chromosome 10 deletion phosphatase( PTEN),human mitochondrial fusion hormone-2,and tumor suppressor gene 7-L were all lower than those in Group A( P < 0. 05). In Group B,with the increase of pathological stages,the patients’ microvascular density,the positive expression rate of angiopoietin-2,and the level of vascular endothelial growth factor gradually increased,while the levels of PTEN,human mitochondrial fusion hormone-2,and tumor suppressor gene 7-L gradually reduced( P < 0. 05). Microvascular density,positive expression rate of angiogen-2 and vascular endothelial growth factor were negatively correlated with pulse index and arterial resistance index,and positively correlated with end-diastolic flow rate,peak flow rate and average flow rate( P <0. 05). PTEN,human mitochondrial fusion hormone-2 and tumor suppressor gene 7-L levels were positively correlated with pulse index and arterial resistance index,and negatively correlated with end-diastolic flow rate,peak flow rate and average flow rate( P < 0. 05).Conclusion The blood flow parameters of transvaginal color Doppler flow imaging can be used as an important sensitive index for the differential diagnosis of benign and malignant ovarian tumors,which is closely related to tumor angiogenesis and disease progression.