肿瘤标志物联合血常规炎性指标、凝血功能指标在上皮性卵巢癌诊断中的价值分析

An Analysis of the Value of Tumor Markers Combined with Blood Routine Inflammatory Markers and Coagulation Function Indicators in the Diagnosis of Epithelial Ovarian Cancer

目的从肿瘤标志物、血常规炎性指标和凝血功能指标中寻找辅助上皮性卵巢癌诊断的血液学指标组合。方法选取2021年5月至2023年5月郑州大学第三附属医院收治的118例上皮性卵巢癌患者为上皮性卵巢癌组,117例卵巢良性肿瘤患者为卵巢良性肿瘤组。检测和比较2组间血液学检验指标的差异,包括肿瘤标志物甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CA15-3、CA125和人附睾蛋白4(HE4),血常规炎性指标血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞和单核细胞比值(LMR)和红细胞分布宽度(RDW),凝血功能指标凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体。选取组间差异有统计学意义的指标通过多因素Logistics回归分析筛选出上皮性卵巢癌的独立危险因素。通过受试者工作曲线(ROC)分析单一指标检测对上皮性卵巢癌的诊断效能。通过二元Logistics回归分析联合ROC曲线分析多指标联合检测对上皮性卵巢癌的诊断效能。结果肿瘤标志物CA15-3、CA125和HE4,血常规炎性指标PLR、NLR和LMR以及凝血功能指标FIB和D-二聚体的表达在上皮性卵巢癌组和卵巢良性肿瘤组之间存在差异,差异具有统计学意义(P<0.05)。多因素分析结果显示CA125、HE4、FIB和D-二聚体是上皮性卵巢癌的独立危险因子(OR>1)。ROC曲线分析结果显示,CA125、HE4、LMR、FIB和D-二聚体对上皮性卵巢癌诊断的AUC分别为0.911、0.933、0.768、0.801和0.872。7种多指标联合检测中,CA125+HE4+LMR+FIB+D-二聚体诊断上皮性卵巢癌的AUC最大,为0.986,灵敏度为96.6%,特异性为96.6%。结论术前血液肿瘤标志联合血常规炎性指标、凝血功能指标的多指标联合检测可以作为上皮性卵巢癌鉴别诊断的一种辅助方法,可为临床提供更有价值的诊断信息。

Objective To search and identify an optimal combination of hematological indicators to assist in the diagnosis of epithelial ovarian cancer(EOC)from tumor markers,blood routine inflammatory indicators,and coagulation function indicators.Methods 118 patients with EOC admitted to the Third Affiliated Hospital of Zhengzhou University from May,2021 to May,2023 were selected as the EOC group,while 117 patients with benign ovarian tumors were selected as the benign ovarian tumor group.We detected and evaluated the differences in hematological test indicators between two groups,including tumor markers alpha fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate antigen-199(CA19-9),CA15-3,CA125,and human epididymal protein 4(HE4),blood routine inflammatory indicators platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR),and red blood cell distribution width(RDW),coagulation function indicators include prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer.We then selected indicators with statistically significant differences between groups and screened for independent risk factors for EOC through logistic regression analysis.We evaluated the diagnostic efficacy of single-indicator detection for EOC through receiver operating curve(ROC)analysis.We also used binary logistic regression analysis combined with ROC curve analysis to evaluate the diagnostic efficacy of multi-indicator combined detection for EOC.Results There were statistically significant differences in the expression of tumor markers CA15-3,CA125,and HE4,blood routine inflammatory markers PLR,NLR,and LMR,as well as coagulation function markers FIB and D-dimer between the EOC group and the ovarian benign tumor group(P<0.05).Multivariate analysis showed that CA125,HE4,FIB,and D-dimer were independent risk factors for EOC(OR>1).ROC curve showed that the AUCs for the diagnosis of EOC by CA125,HE4,LMR,FIB,and D-dimer were 0.911,0.933,0.768,0.801,and 0.872,respectively.Among 7 multi-indicator combined tests,CA125+HE4+LMR+FIB+D-dimer had the highest AUC for diagnosing EOC,with a value of 0.986,sensitivity of 96.6%,and specificity of 96.6%.Conclusion The combined detection of preoperative blood tumor markers,blood routine inflammatory indicators,and coagulation function indicators can serve as an auxiliary method for the differential diagnosis of EOC.This method will provide valuable diagnostic information for the clinical practice.