经阴道彩色多普勒超声联合血清肿瘤标志物对卵巢癌TNM分期的诊断价值

Diagnostic value of transvaginal color Doppler ultrasonography combined with serum tumor markers in TNM staging of ovarian cancer

目的探讨经阴道彩色多普勒超声(TVCDS)联合血清肿瘤标志物检测对卵巢癌TNM分期的诊断价值。方法选取120例卵巢癌患者和120例健康体检者,分别作为观察组和对照组,比较两组受试者及不同TNM分期卵巢癌患者TVCDS检查血流参数[阻力指数(RI)、搏动指数(PI)、峰值流速(PSV)及舒张末期流速(EDV)]和血清肿瘤标志物[人附睾蛋白4(HE4)、可溶性B7-H4蛋白(sB7-H4)、甲胎蛋白(α-fetal protein,AFP)]水平。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估TVCDS检查血流参数和血清肿瘤标志物单独及联合检测对卵巢癌TNM分期的诊断价值。结果观察组患者的RI明显低于对照组,PI、PSV、EDV均明显高于对照组,差异均有统计学意义(P<0.01)。120例卵巢癌患者中,Ⅰ~Ⅱ期66例,Ⅲ~Ⅳ期54例,Ⅰ~Ⅱ期卵巢癌患者的RI明显高于Ⅲ~Ⅳ期患者,PI、PSV、EDV均明显低于Ⅲ~Ⅳ期患者,差异均有统计学意义(P<0.01)。观察组患者的血清HE4、sB7-H4、AFP水平均明显高于对照组,差异均有统计学意义(P<0.01)。Ⅰ~Ⅱ期卵巢癌患者的血清HE4、sB7-H4、AFP水平均明显低于Ⅲ~Ⅳ期患者,差异均有统计学意义(P<0.01)。TVCDS检查血流参数联合血清HE4、sB7-H4、AFP检测诊断卵巢癌TNM分期的AUC为0.967(95%CI:0.226~0.999),大于各指标单独检测。结论TVCDS检查血流参数联合血清HE4、sB7-H4、AFP检测对卵巢癌TNM分期的诊断价值较高。

Objective To investigate the diagnostic value of transvaginal color Doppler ultrasonography(TVCDS)combined with serum tumor markers in TNM staging of ovarian cancer.Method A total of 120 patients with ovarian cancer and 120 health subjects were selected into the observation group and control group respectively.The TVCDS blood flow parameters[resistance index(RI),pulsatility index(PI),peak systolic veloci(PSV),end diastolic velocity(EDV)]and detection of serum tumor markers[human epididymis protein 4(HE4),soluble B7-H4 protein(sB7-H4)andα-fetal protein(AFP)]levels in two groups and with different TNM stages were compared.Draw the receiver operating characteristic(ROC)curve,calculate the area under the curve(AUC),and evaluate the diagnostic value of TVCDS blood flow parameters and serum tumor markers for TNM staging of ovarian cancer.Result The RI of observation group was lower than that of the control grroup,the PI,PSV and EDV were higher than those of the control group,the differences were statistically significant(P<0.01).Among 120 patients with ovarian cancer,66 patients at stageⅠ-Ⅱ,54 patients at stageⅢ-Ⅳ.RI of patients with stageⅠ-Ⅱovarian cancer was significantly higher than that of stageⅢ-Ⅳ,and PI,PSV,EDV were significantly lower than those of stageⅢ-Ⅳ,the differences were statistically significant(P<0.01).The levels of serum HE4,sB7-H4 and AFP in the observation group were significantly higher than those in the control group,the differences were statistically significan(P<0.01).The levels of serum HE4,sB7-H4 and AFP in patients with stage III ovarian cancer were significantly lower than those of stage III-IV,the differences were statistically significant(P<0.01).The AUC of TVCDS blood flow parameters combined with serum HE4,sB7-H4,AFP in diagnosing TNM stage of ovarian cancer was 0.967(95%CI:0.226-0.999),which was higher than each index detected separately.Conclusion TVCDS examination of blood flow parameters combined with serum HE4,sB7-H4,AFP detection has a high diagnostic efficiency for TNM staging of ovarian cancer.