儿童附件肿瘤合并卵巢扭转的临床特征及诊断预测

Clinical features and diagnostic prediction of ovarian torsion in children with adnexal tumors

目的分析附件肿瘤合并卵巢扭转的临床特征,创建一个预测评分系统帮助卵巢扭转的诊断。方法连续纳入2018年10月至2019年10月在北京儿童医院肿瘤外科诊断为附件肿瘤的患儿60例,查阅病历收集患儿临床表现、相关检验及影像学结果,根据术中情况,将51例单侧附件肿瘤患儿,分为扭转组和对照组,比较分析所有临床特征,创建预测评分系统,回顾性验证预测评分,绘制受试者曲线,计算曲线下面积、灵敏度及特异度。结果两组比较,年龄、BMI及肥胖差异无统计学意义(P>0.05),急性或亚急性腹痛、恶心呕吐、发热、偶然发现肿块、腹部压痛、CRP升高、WBC升高、催乳素水平、血清黄体酮水平、AFP水平及肿瘤最大径差异有统计学意义(P<0.05),肿瘤最大径的两个最佳截断值为6 cm和13.5 cm。将急性或亚急性腹痛、恶心呕吐、发热、腹部压痛、WBC升高和肿瘤最大径这6个指标整合为预测评分,受试者曲线下面积为0.95238,最佳截断值是4分,预测评分的灵敏度为81.0%,特异度为96.7%。结论相比单纯附件肿瘤患儿,急性或亚急性腹痛、恶心呕吐、发热、腹部压痛、CRP升高、WBC升高以及最大径在6至13.5 cm之间的肿瘤更多发生在合并卵巢扭转的附件肿瘤患儿中,预测评分有较好的灵敏度和特异度,可辅助附件肿瘤合并卵巢扭转的诊断。催乳素、血清黄体酮及AFP与卵巢扭转的关系还需进一步研究探讨。

Objective To explore the clinical features of ovarian torsion in children with adnexal tumors and create a predictive score to aid in its diagnosis.Methods Sixty children with adnexal tumor diagnosed from October 2018 to October 2019 were enrolled.The clinical manifestations,relevant examinations and imaging findings were collected.Fifty-one children with unilateral adnexal tumor were divided into torsion and control groups.All clinical features were compared and analyzed and predictive score was established and verified.And the receiver operating characteristic curve was plotted.The area,sensitivity and specificity under the curve were calculated.Results No significant inter-group differences existed in age,body mass index(BMI)or obesity.However,there were significant differences in acute or subacute abdomen,nausea&vomiting,fever,accidental mass,abdominal tenderness,elevated C-reactive protein(CRP),leucocytosis,prolactin,serum progesterone,alpha fetoprotein(AFP)and maximal diameter of tumor.The two optimal cutoff values for maximal diameter of tumor were 6 and 13.5 cm.The six parameters of acute or subacute abdominal pain,nausea&vomiting,fever,abdominal tenderness,leucocytosis and maximal diameter of tumor were integrated into the predictive score.The area under the subject curve was 0.95238,the best cut-off value 4 points,the sensitivity of predictive score 81.0%and the specificity 96.7%.Conclusions As compared with children with simple adnexal tumors,acute or subacute abdominal pain,nausea&vomiting,fever,abdominal tenderness,elevated CRP,leucocytosis and tumors with a maximal diameter of 6 to 13.5 cm are more likely to occur in children with adnexal tumors with ovarian torsion.The predictive score offers better profiles of sensitivity and specificity and can assist the diagnosis of adnexal tumors with ovarian torsion.The relationship between prolactin,serum progesterone,AFP and ovarian torsion requires further studies.