炎症反应指标联合肿瘤标志物诊断成熟性囊性畸胎瘤蒂扭转的价值

The value of inflammatory markers combined with tumor markers in the diagnosis of torsion of mature ovarian teratoma

目的探讨炎症反应指标[中性粒细胞/淋巴细胞(NLR)、单核细胞/淋巴细胞(MLR)、血小板/淋巴细胞(PLR)]联合肿瘤标志物[糖类抗原(CA)125、CA199]在成熟性囊性畸胎瘤(MCT)蒂扭转中的诊断价值。方法回顾性分析2013年3月至2019年10月中山大学附属第三医院收治的经手术病理确诊的成熟性囊性畸胎瘤患者的临床资料,其中观察组蒂扭转患者31例、对照组无蒂扭转患者101例,所有患者术前均行血常规、CA125、CA199检测,并将数据进行统计学分析。结果观察组炎症反应指标及肿瘤标志物均高于对照组,其中NLR、MLR、PLR、CA125组间对比差异有统计学意义(P<0.05)。单因素回归分析筛选出具有统计学意义的变量NLR、PLR、CA125、CA199(P<0.05),多因素logistic回归构建出具有统计学意义的NLR、CA199联合诊断预测模型(P<0.05)。NLR、PLR、CA125、CA199以及NLR、CA199联合预测模型在鉴别成熟性囊性畸胎瘤是否蒂扭转的曲线下面积AUC分别为0.83、0.72、0.69、0.60、0.86,其中以NLR、CA199联合预测模型的诊断效能最高,其灵敏度77.42%,特异度82.18%。观察组中,运用NLR、CA199联合预测模型诊断MCT蒂扭转准确度较超声高(87.10%vs 61.29%),但依据临床症状及超声检查诊断MCT蒂扭转的准确度为90.32%。结论炎症反应指标、肿瘤标志物在诊断成熟性囊性畸胎瘤蒂扭转中有一定临床意义,其中NLR、CA199联合诊断效能较单一指标高。临床上仍需结合患者症状体征、彩色超声等辅助检查结果提高诊断准确性。

Objective To investigate the diagnostic efficacy of inflammatory biomarkers[neutrophil/lymphocyte(NLR),monocyte/lymphocyte(MLR),platelet/lymphocyte(PLR)]combined with tumor markers[carbohydrate antigen(CA)125,CA199]in mature cystic teratoma(MCT)patients possess torsion.Methods The clinical data of patients with MCT diagnosed by surgery and pathology in the third Affiliated Hospital of Sun Yat-Sen University from March 2013 to October 2019 were retrospectively analyzed.A total of 31 MCT patients with torsion were included in observation group,another 101 MCT patients without torsion were assigned to the control group.Clinical characteristics and the levels of NLR,MLR,PLR,CA125,CA199 were assessed and analyzed.Results The inflammatory biomarkers(NLR,MLR,PLR)and tumor markers(CA125)in the observation group were higher than those in the control group(P<0.05).Univariate regression analysis was used to screen variables with statistical significance,including NLR,PLR,CA125 and CA199(P<0.05),and multivariate logistic regression was used to construct a prediction model for diagnose MCT patients with torsion,which combined NLR and CA199(P<0.05).The area under curve(AUC)of NLR,PLR,CA125,CA199 and the combined prediction models of NLR and CA199 were 0.83,0.72,0.69,0.60 and 0.86,respectively.Among them,the joint prediction model of NLR and CA199 had the highest diagnostic efficiency,with a sensitivity of 77.42%and a specificity of 82.18%(P<0.05).In the observation group,the accuracy of combined prediction model of NLR and CA199 in the diagnosis of MCT pedicle torsion was higher than that of ultrasound(87.10%vs 61.29%),but according to the clinical symptoms and ultrasonic examination,90.32%of the patients were diagnosed as MCT pedicle torsion.Conclusions The inflammatory biomarkers and tumor markers have useful clinical significance in the diagnosis of MCT with torsion,especially the combine measurement of NLR and CA199.Associated with the patient's symptoms,signs,examination included doppler ultrasound may assist in improving the diagnostic accuracy.