膀胱癌骨转移的相关预测及诊断因素分析  

The risk factors for predicting or diagnosing bone metastases from urinary bladder neoplasms

作　　者：兰敏 刘家明[1] 徐佳佳[1] 刘明军[1] 陈文昭[1] 陈宣银[1] 黄山虎[1] 刘志礼[1] LAN Min;LIU Jia-ming;XU Jia-jia;LIU Ming-jun;CHEN Wen-zhao;CHEN Xuan-yin;HUANG Shan-hu;LIU Zhi-li(Department of Orthopedics, First Affiliated Hospital of Nanchang University, Nanchang 330006, Chin)

机构地区：[1]南昌大学第一附属医院骨科,南昌330006

出　　处：《解放军医学杂志》2018年第1期51-55,共5页Medical Journal of Chinese People's Liberation Army

基　　金：江西省科技厅人才计划项目(20162BCB22022;20162BCB23057)~~

摘　　要：目的探讨血钙、血清碱性磷酸酶(ALP)及血红蛋白(Hb)水平对膀胱癌骨转移的预测及诊断价值。方法纳入经病理诊断为膀胱癌且后期有骨转移的患者35例(骨转移组),并按1:3比例纳入同期105例性别、年龄和随访时间匹配的膀胱癌无骨转移患者(无骨转移组),比较分析两组血钙、ALP及Hb的差异,探讨其在膀胱癌骨转移中的预测及诊断价值。结果初诊和随访时骨转移组患者的血钙、ALP及Hb水平均明显高于无骨转移组(P<0.05)。Logistic回归分析结果显示,初诊膀胱癌时血钙、ALP、Hb水平是预测患者后期发生骨转移的独立危险因素,随访时血钙、ALP、Hb水平是判断患者是否合并骨转移的独立危险因素(P<0.05)。ROC曲线分析显示血钙、ALP、Hb水平可较准确预测初诊膀胱癌是否会发生后期骨转移(曲线下面积分别为0.615、0.704、0.692,截断值分别为2.55mmol/L、97.0U/L、101.5g/L)及诊断随访时膀胱癌的骨转移(曲线下面积分别为0.706、0.776、0.829,截断值分别为2.46mmol/L、112.5U/L、103.5g/L)。结论血钙、ALP、Hb水平可用于预测初次诊断膀胱癌发生骨转移的风险及判断后期随访患者是否合并骨转移。Objective To explore the clinical significance of some risk factor, such as blood calcium serum alkaline phosphatase（ALP） and hemoglobin（Hb） for predicting or diagnosing bone metastases from urinary bladder neoplasms. Methods A total of 35 patients diagnosed as urinary bladder neoplasms and bone metastasis based on the histopathologic analysis（bone metastasis group, BM）, and 105 cases of age-, sex-and follow-up time matched urinary bladder neoplasms patients without bone metastasis（non bone metastasis group, NBM） were included in present study. The correlations between clinical-pathological parameters（blood calcium, ALP, Hb） and bone metastases from urinary bladder neoplasms were analyzed and the risk factors for predicting or diagnosing bone metastases were identified. Results The levels of blood calcium, ALP and Hb were significantly higher at first diagnosis and follow-up period in BM group than in NBM group（P〈0.05）. Multivariate logistic regression analysis indicated that the levels of calcium, ALP and Hb at first diagnosis were the independent risk factors for predicting the later incidence of bone metastases（P〈0.05）. The levels of calcium, ALP and Hb in follow-up period were the independent risk factors for diagnosing bone metastases（P〈0.05）. Receiver operating characteristic（ROC） curves analysis showed that the levels of calcium, ALP, Hb may give a more accurate prediction on bone metastases（AUC： 0.615, 0.704, 0.692; cut-off： 2.55 mmol/L, 97.0 U/L, 101.5 g/L, respectively） or diagnosing bone metastases（AUC： 0.706, 0.776, 0.829; cut-off： 2.46 mmol/L, 112.5 U/L, 103.5 g/L, respectively）. Conclusion The levels of blood calcium, ALP and Hb may be used to predict the risk of bone metastases for patients firstly diagnosed as urinary bladder neoplasms, and predict whether the patients will be complicated with bone metastases during follow-up period.

关 键 词：膀胱肿瘤 骨转移 危险因素 诊断 

分 类 号：R737.14[医药卫生—肿瘤]