摘要
目的探讨血清肿瘤标志物联合输卵管造影对输卵管癌和输卵管假癌性增生的鉴别诊断价值。方法回顾性选择2016年1月至2021年1月在辽阳市中心医院妇产科诊治的80例患者,包括40例输卵管癌患者和40例输卵管假癌性增生患者。选择40名在本院体检的健康志愿者作为健康对照组。通过静脉穿刺采集静脉血样本,使用Cobase 601分析仪及配套试剂检测血清中人附睾蛋白4(HE4)和糖类抗原125(CA125)水平。通过彩色多普勒超声诊断仪进行输卵管超声造影。比较受试者临床特征、血清肿瘤标志物水平;比较各组受试者血清肿瘤标志物联合输卵管造影检测阳性率;分析血清肿瘤标志物联合输卵管造影检测对输卵管癌、输卵管假癌性增生的诊断价值;分析影响输卵管癌与输卵管假癌性增生检测阳性率的因素。结果健康志愿者无症状。输卵管癌组较假癌性增生组腹胀或腹痛、盆腔肿块和阴道异常出血患者增加,差异均有统计意义(P<0.05)。与正常对照组相比,假癌性增生组和输卵管癌组血清肿瘤标志物HE4和CA125水平增加,且输卵管癌组较假癌性增生组HE4和CA125水平增加,差异均有统计意义(P<0.05)。与HE4和CA125单独检测相比,HE4+CA125检测和HE4+CA125+造影检测阳性率增加(P<0.05),且与HE4+CA125检测相比,HE4+CA125+造影检测阳性率增加,差异均有统计意义(P<0.05)。与正常对照组相比,假癌性增生组和输卵管癌组HE4、CA125、HE4+CA125和HE4+CA125+造影检测阳性率增加(P<0.05),且输卵管癌组较假癌性增生组HE4、CA125、HE4+CA125和HE4+CA125+造影检测阳性率增加,差异均有统计意义(P<0.05)。在输卵管癌及输卵管假癌性增生的诊断中,与CA125检测相比,HE4检测敏感度降低,特异度升高。与HE4和CA125单独检测相比,HE4+CA125检测和HE4+CA125+造影检测敏感度和特异度均升高,且输卵管癌组较假癌性增生组HE4、CA125、HE4+CA125和HE4+CA125+造影检测敏感度增加(P<0.05)。输卵管癌与输卵管假癌性增生检测阳性率与癌或增生部位、癌或增生组织大小、HE4、CA125、造影密切相关(P<0.001)。结论血清肿瘤标志物联合输卵管造影增加检测敏感度和特异度,有利于区分输卵管癌和输卵管假癌性增生的鉴别诊断。
Objective To investigate the value of serum tumor markers combined with tubal angiography in the differential diagnosis of fallopian tube cancer and fallopian tube pseudocancerous hyperplasia.Methods A total of 80 patients diagnosed and treated in the Department of Obstetrics and Gynecology of Liaoyang Central Hospital from January 2016 to January 2021,including 40 patients with fallopian tube cancer and 40 patients with fallopian tube pseudocancerous hyperplasia.Forty healthy volunteer patients undergoing physical examination in Liaoyang Central Hospital were retrospectively selected as the healthy control group.Venous blood samples were collected by venipuncture,and serum human epididymal protein 4(HE4)and carbohydrate antigen 125(CA125)levels were detected by Cobase 601 analyzer and supporting reagents.Color Doppler ultrasound system was used for contrast-enhanced fallopian tube ultrasound.The clinical characteristics and serum tumor marker levels of subjects in each group were compared;the positive rates of serum tumor markers combined with salpingography were compared in each group.The diagnostic value of the hyperplasia was analyzed.Factors affecting the detection rate of fallopian tube carcinoma and tubal pseudocancerous hyperplasia were analyzed.Results The healthy volunteers were asymptomatic.Compared with the pseudocancerous hyperplasia group,patients with abdominal distension or abdominal pain,pelvic mass and abnormal vaginal bleeding increased in the fallopian tube cancer group,the differences were statistically significant(P<0.05).Compared with the normal control group,the serum tumor markers HE4 and CA125 levels increased in the pseudocancerous hyperplasia group and fallopian tube cancer group(P<0.05),and the levels of HE4 and CA125 in the fallopian tube cancer group were higher than those in the pseudocancerous hyperplasia group,the differences were statistically significant(P<0.05).Normal fallopian tubes were usually not visible on pelvic MRI.In the presence of fluid in the abdominal cavity,they may be seen as pairs of thin structures extending from the ovaries to the uterine horns,located on the upper edge of the broad ligament.Compared with the detection of HE4 and CA125 alone,the positive rate of HE4+CA125 detection and HE4+CA125+contrast detection increased(P<0.05),and compared with HE4+CA125 detection,the positive rate of HE4+CA125+contrast detection increased,the differences were statistically significant(P<0.05).Compared with the normal control group,the positive rates of HE4,CA125,HE4+CA125,and HE4+CA125+contrast detection in the pseudocancerous hyperplasia group and fallopian tube cancer group increased(P<0.05),and compared with the pseudocancerous hyperplasia group,the positive rate of HE4,CA125,HE4+CA125 and HE4+CA125+contrast detection in the fallopian tube cancer group increased,the differences were statistically significant(P<0.05).In the diagnosis of fallopian tube cancer,compared with CA125 detection,HE4 detection sensitivity was reduced and specificity increased.Compared with the detection of HE4 and CA125 alone,the sensitivity and specificity of HE4+CA125 and HE4+CA125+contrast detection were higher.In the diagnosis of fallopian tube pseudocancerous hyperplasia,compared with CA125 detection,HE4 detection sensitivity reduced and specificity increased.Compared with the detection of HE4 and CA125 alone,the sensitivity and specificity of HE4+CA125 detection and HE4+CA125+contrast detection were both higher.Compared with HE4+CA125 detection,the sensitivity and specificity of HE4+CA125+contrast detection increased.Compared with the pseudocancerous hyperplasia group,the detection sensitivity of HE4,CA125,HE4+CA125 and HE4+CA125+contrast detection in the fallopian tube cancer group increased(P<0.05).The positive rate of fallopian tube cancer and fallopian tube pseudocancerous hyperplasia was closely related to the location of cancer or hyperplasia,the size of cancer or hyperplasia tissue,HE4,CA125,and angiography(P<0.001).Conclusion The combination of serum tumor markers and salpingography increases the sensitivity and specificity of detection,which is helpful to distinguish fallopian tube cancer and fallopian tube pseudocancerous hyperplasia in the differential diagnosis.
作者
岳丽丽
陈蓓蓓
关丽萍
YUE Li-li;CHEN Bei-bei;GUAN Li-ping(Department of Ultrasound,Liaoyang Central Hospital,Liaoyang Liaoning 111000,China.)
出处
《临床和实验医学杂志》
2022年第3期317-320,共4页
Journal of Clinical and Experimental Medicine
基金
辽宁省高等学校基本科研项目(编号:LQNK201713)。
