MRI联合肿瘤标志物在卵巢肿瘤诊断中的应用价值

doi:10.3760/cma.j.issn.1007-1245.2022.13.001

摘要/Abstract

摘要： 目的　探讨磁共振成像（MRI）和血清肿瘤标志物在卵巢肿瘤诊断中的价值以便更好指导治疗方式的选择。方法　选择2019年1月至2020年12月滨州医学院附属医院妇科收治的卵巢恶性肿瘤患者60例（恶性组），年龄18～80岁，平均年龄为56.13岁。选取同期收治的良性肿瘤患者330例（良性组），年龄16～77岁，平均年龄43.27岁。收集两组患者的MRI及血清肿瘤标志物检测结果，以病理结果为金标准，SPSS 26.0软件作为统计学分析软件，计量资料采用t检验，计数资料采用卡方检验，评估MRI、血清肿瘤标志物及其联合检测在卵巢良、恶性肿瘤术前诊断中的应用价值，并经受试者工作特征曲线（ROC）分析各项血清肿瘤标志物预测卵巢恶性肿瘤的效能。结果　恶性组肿瘤在MRI中多表现为边界不清或欠清，肿瘤性质多为囊实性或实性，MRI强化检查多为明显强化，磁共振加权成像（DWI）多呈明显高信号；良性肿瘤在MRI中多表现为边界清晰，肿瘤性质多为囊性，MRI强化检查多为不强化或轻度强化，DWI上多呈稍高信号或等信号，组间差异有统计学意义（P<0.05）。恶性组血清糖类抗原（CA）125、CA199、癌胚抗原（CEA）、人附睾蛋白4（HE4）的水平分别为（885.37±159.14）U/ml、（236.69±65.31）U/ml、（27.49±11.75）μg/L、（364.21±54.08）pmol/L，均高于良性组［（150.44±40.45）U/ml、（92.20±19.64）U/ml、（5.68±0.66）μg/L、（178.73±7.39）pmol/L］，差异均有统计学意义（t=4.476、2.119、2.423、3.398，均P<0.05）。恶性组血清CA125、CA199、CEA、HE4及其联合检查的阳性检出率分别为73.33%（44/60）、33.33%（20/60）、23.33%（14/60）、53.33%（32/60）、90.00%（54/60），均高于良性组［13.94%（46/330）、17.88%（59/330）、8.18%（27/330）、2.73%（9/330）、33.03%（109/330）］，差异均有统计学意义（χ²=100.891、7.507、12.389、132.105、67.734，均P<0.05）；经ROC分析，CA125、CA199、HE4、CEA对卵巢恶性肿瘤的诊断效能的曲线下面积（AUC）分别为0.867、0.525、0.893、0.540；MRI诊断卵巢肿瘤的灵敏度为83.33%、特异度为96.97%、准确度为96.15%；4种肿瘤标志物联合诊断卵巢肿瘤的灵敏度为90.00%、特异度为66.96%、准确度为70.51%；MRI与4种肿瘤标志物联合检测诊断的灵敏度为95.00%，特异度为99.39%、准确度为98.72%，差异均有统计学意义（均P<0.05）。结论　MRI联合肿瘤标志物在卵巢肿瘤诊断中的应用价值大于单一MRI或血清肿瘤标志物的检测。MRI联合肿瘤标志物在卵巢肿瘤的诊断中具有重要意义，值得临床应用。

关键词: 卵巢肿瘤, 恶性肿瘤, 良性肿瘤, 核磁共振成像, 肿瘤标志物, 糖类抗原125, 糖类抗原199, 癌胚抗原, 人附睾蛋白4

Abstract: Objective　To explore the value of magnetic resonance imaging (MRI) and serum tumor markers in the diagnosis of ovarian tumors and to better guide the treatment choice. Methods　From January 2019 to December 2020, 60 patients with ovarian malignant tumors who were 18-80 years old, with an average of 56.13 and were treated at Department of Obstetrics and Gynecology, Binzhou Medical University Hospital were selected as a malignant group, and 330 patients with benign tumors who were 16-77 years old, with an average of 43.27 and were treated at Binzhou Medical University Hospital were selected as a benign group. The results of MRI and serum tumor marker detection in both groups were collected. The pathological results were used as the gold standard. SPSS 26.0 software was used as the statistical analysis software. t test was used for the measurement data, and chi-square test for the enumeration data. The application values of MRI, serum tumor markers, and their combined detection in the preoperative diagnosis of ovarian benign and malignant tumors were evaluated, and receiver operating characteristic curve (ROC) was used to analyze the efficacy of each serum tumor marker in predicting ovarian malignant tumors. Results　The malignant tumors in the malignant group were mostly characterized by unclear borders on MRI, and the tumor properties were mostly cystic or solid; the enhanced MRI examinations were mostly markedly enhanced, and the MRI-weighted imaging (DWI) showed obviously high signal. The benign tumors mostly showed clear borders on MRI; most tumors were cystic; most of them were non-enhanced or mildly enhanced on MRI, and most of them showed slightly hyperintensity or isointensity on DWI. The difference between these two groups was statistically significant (P<0.05). The serum levels of carbohydrate antigen-125 (CA125), carbohydrate antigen-199 (CA199), carcinoembryonic antigen (CEA), and human epididymal protein 4 (HE4) were (885.37±159.14) U/ml, (236.69±65.31) U/ml, (27.49±11.75) μg/L, and (364.21±54.08) pmol/L in the malignant group, which were higher than those in the benign group [(150.44±40.45) U/ml, (92.20±19.64) U/ml, (5.68±0.66) μg/L, and (178.73±7.39) pmol/L], with statistical differences (t=4.476, 2.119, 2.423, and 3.398; all P<0.05). The positive detection rates of CA199, CEA, HE4, and their combination were 73.33% (44/60), 33.33% (20/60), 23.33% (14/60), 53.33% (32/60), and 90.00% (54/60) in the malignant group, which were higher than those in the benign group [13.94% (46/330), 17.88% (59/330), 8.18% (27/330), 2.73% (9/330), and 33.03% (109/330)], with statistical differences (χ²=100.891, 7.507, 12.389, 132.105, and 67.734; all P<0.05). The ROC analysis showed that the areas under the curves (AUC) of CA125, CA199, HE4, and CEA in the diagnosis of ovarian malignant tumors were 0.867, 0.525, 0.893, and 0.540, respectively; the sensitivity of MRI in the diagnosis of ovarian tumors was 83.33%, the specificity was 96.97%, and the accuracy was 96.15%; the sensitivity of the four tumor markers combined to diagnose ovarian tumors was 90.00%, the specificity was 66.96%, and the accuracy was 70.51%; the combination of MRI and the four tumor markers had a sensitivity of 95.00% and a specificity of 99.39%, and the accuracy was 98.72%; the differences were statistically significant (all P<0.05). Conclusions　The application value of MRI combined with tumor markers in the diagnosis of ovarian tumors is greater than that of single MRI or serum tumor markers. MRI combined with tumor markers is of great significance in the diagnosis of ovarian tumors and is worthy of clinical application.

Key words: Ovarian tumors, Malignant tumors, Benign tumors, Magnetic resonance imaging, Tumor markers, CA125, CA199, CEA, HE4

史文燕　朱建业　管东东. MRI联合肿瘤标志物在卵巢肿瘤诊断中的应用价值[J]. 国际医药卫生导报, 2022, 28(13): 1778-1783.

Shi Wenyan, Zhu Jianye, Guan Dongdong. MRI combined with tumor markers in diagnosis of ovarian tumors[J]. International Medicine and Health Guidance News, 2022, 28(13): 1778-1783.

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