D-二聚体在未治卵巢癌患者深静脉血栓发生诊断中的价值

Value of D-dimer in diagnosing deep venous thrombosis for ovarian cancer before treatment

目的探讨血清D-二聚体检测在未接受临床治疗的卵巢癌患者中诊断深静脉血栓发生的价值。方法选取2017年6月至2019年3月在新疆医科大学第一附属医院经手术或病理诊断的卵巢癌患者110例,于临床干预治疗前完善卵巢肿瘤标志物糖类抗原125(CA125)和人附睾蛋白4(HE4)检测,血浆D-二聚体(DD)检测,以及妇科B超、双下肢血管B超、肺部血管造影(CTA)检查。分析卵巢癌患者中深静脉血栓的发生情况,比较CA125、HE4和DD水平在卵巢癌不同分期中的差异,以及CA125、HE4、DD在卵巢癌患者深静脉血栓发生诊断中的价值。结果 15.5%的卵巢癌患者在临床干预治疗前发生了深静脉血栓,其中94.2%的深静脉血栓患者为晚期卵巢癌,88.2%的深静脉血栓患者无明显临床症状。在未治卵巢癌患者中,形成深静脉血栓与未形成深静脉血栓组间比较,血浆DD水平差异有统计学意义(P<0.001);血清CA125及HE4水平差异无统计学意义(P>0.05)。血浆DD水平诊断卵巢癌深静脉血栓形成的灵敏度为70.6%,特异度为89.2%,阳性预测值54.5%,阴性预测值94.3%,截断值为1 894.0ng/mL。结论未治卵巢癌患者无症状性深静脉血栓发生的概率较高;血浆DD水平对未治卵巢癌深静脉血栓发生有诊断价值;选择合适的血浆DD诊断截断值,可有效协助临床诊断未治卵巢癌深静脉血栓的发生。

Objective To investigate the value of D-dimer in diagnosing deep venous thrombosis(DVT)occurrence for the patients with ovarian cancer without receiving treatment.Methods A total of 110 patients with operated or pathologically diagnosed ovarian cancer in the First Affiliated Hospital of Xinjiang Medical University from June 2017 to March 2019 were selected.The examinations of ovarian tumor markers carbohydrate antigen 125(CA125),human epididymal protein 4(HE4),plasma D-dimer(DD),gynecological ultrasonography,and vascular ultrasonography of both lower extremities and computed tomography(CT)pulmonary angiography were completed before operation.The occurrence situation of DVT among the patients with ovarian cancer was analyzed.The differences of CA125,HE4 and DD among different stages of ovarian cancer were analyzed.The value of CA125,HE4,DD in diagnosing DVT occurrence of ovarian cancer analyzed.Results DVT occurred in 15.5%of patients with ovarian cancer before clinical intervention,in which 94.2%of the patients with DVT had advanced ovarian cancer,and 88.2%of the patients with DVT had no obvious symptoms.Among the patients with untreated ovarian cancer,there was the statistically significant difference in plasma DD level between the DVT formation group and unformed DVT group(P<0.001).There was no statistically significant difference in serum CA125 and HE4 levels(P>0.05).The sensitivity,specificity,positive predictive value,negative predictive value,and cut-off value of plasma DD level for diagnosing ovarian cancer DVT were 70.6%,89.2%,54.5%,94.3%and 1894.0 ng/mL respectively.Conclusion The incidence rate of asymptomatic DVT in the patients with untreated ovarian cancer is high.Plasma DD level has diagnostic value for the occurrence of untreated ovarian cancer DVT.The selection of appropriate DD cut-off value can effectively assist the clinic in diagnosing DVT in untreated ovarian cancers.