经阴道三维超声检测最大肿瘤直径联合外周血鳞状上皮细胞癌抗原水平对局部晚期及晚期宫颈癌的诊断价值  

Diagnostic value of maximum tumor diameter detected by three-dimensional transvaginal ultrasound combined with peripheral blood squamous cell carcinoma antigen for locally advanced and advanced cervical cancer

作　　者：高璐璐 席登峰 祖逸峥 陈华[2] 苏育欣 靳雁 李贝 张瑞琪 张少华 哈春芳[1,2,6] GAO Lulu;XI Dengfeng;ZU Yizheng;CHEN Hua;SU Yuxin;JIN Yan;LI Bei;ZHANG Ruiqi;ZHANG Shaohua;HA Chunfang(School of Clinical Medicine,Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of Gynecology,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Clinical School of Obstetrics and Gynecology,Fujian Medical University,Fuzhou 350001,Fujian Province,China;Department of Obstetrics and Gynecology,Lingwu People′s Hospital,Lingwu 750499,Ningxia Hui Autonomous Region,China;Department of Gynecology,the First Affiliated Hospital of Xi′an Medical University,Xi′an 710077,Shaanxi Province,China;Key Laboratory of Fertility Preservation and Maintenance,Ministry of Education,Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750004 [2]宁夏医科大学总医院妇科,宁夏银川750004 [3]福建医科大学妇儿临床医学院,福建福州350001 [4]灵武市人民医院妇产科,宁夏灵武750499 [5]西安医学院第一附属医院妇科,陕西西安710077 [6]宁夏医科大学生育力保持教育部重点实验室,宁夏银川750004

出　　处：《新乡医学院学报》2023年第3期224-229,共6页Journal of Xinxiang Medical University

基　　金：宁夏回族自治区中央引导地方科技发展专项(编号:2022FRD05034);宁夏自然科学基金资助项目(编号:2021A1337,2022AAC03493)。

摘　　要：目的探讨经阴道三维超声检测最大肿瘤直径(MTD)联合外周血鳞状上皮细胞癌抗原(SCC-Ag)水平对局部晚期及晚期宫颈癌的诊断价值。方法选择2020年10月至2022年1月宁夏医科大学总医院收治的204例宫颈癌患者为研究对象。年龄26~80(51.82±11.00)岁;国际妇产科联盟(FIGO)分期≤ⅡA期130例,≥ⅡB期74例;宫颈鳞状细胞癌166例,非鳞状细胞癌38例;低/中分化58例,高分化146例。采用经阴道三维超声检测患者首次诊断时的MTD,免疫化学发光法检测治疗前患者外周血SCC-Ag水平。比较不同FIGO分期、组织类型、分化程度患者的MTD及外周血SCC-Ag水平,分析MTD、SCC-Ag与宫颈癌FIGO分期、组织类型、分化程度的相关性;采用受试者操作特征(ROC)曲线分析MTD、SCC-Ag单独和联合对≥ⅡB期宫颈癌的诊断效能。结果≥ⅡB期组患者的外周血SCC-Ag水平显著高于≤ⅡA期组,MTD显著大于≤ⅡA期组(P<0.05)。鳞状细胞癌组患者的外周血SCC-Ag水平显著高于非鳞状细胞癌组(P<0.05);非鳞状细胞癌组患者SCC-Ag阳性13例(34.2%),鳞状细胞癌组患者SCC-Ag阳性111例(66.9%),非鳞状细胞癌组患者SCC-Ag阳性率显著低于鳞癌组(χ^(2)=13.834,P<0.05)。鳞状细胞癌组与非鳞状细胞癌组患者的MTD比较差异无统计学意义(P>0.05)。低/中分化组患者的MTD显著大于高分化组(P<0.05),2组患者的外周血SCC-Ag水平比较差异无统计学意义(P>0.05)。SCC-Ag、MTD与FIGO分期呈正相关(r=0.484、0.544,P<0.05);MTD与分化程度呈负相关(r=-0.166,P<0.05),SCC-Ag与分化程度无相关性(r=-0.027,P>0.05)。SCC-Ag、MTD单独诊断≥ⅡB期宫颈癌的ROC曲线下面积(AUC)分别为0.790、0.824,SCC-Ag与MTD联合诊断≥ⅡB期宫颈癌的AUC为0.855;SCC-Ag联合MTD诊断≥ⅡB期宫颈癌的AUC显著大于单独SCC-Ag、MTD诊断(Z=1.956、2.152,P<0.05);单独SCC-Ag与单独MTD诊断≥ⅡB期宫颈癌的AUC比较差异无统计学意义(Z=0.789,P>0.05)。结论宫颈癌患者�Objective To investigate the diagnostic value of maximum tumor diameter(MTD)detected by three-dimensional transvaginal ultrasound combined with peripheral blood squamous cell carcinoma antigen(SCC-Ag)for locally advanced and advanced cervical cancer.Methods A total of 204 cervical cancer patients admitted to the General Hospital of Ningxia Medical University from October 2020 to January 2022 were selected as the research subjects.They were aged 26-80(51.82±11.00)years;the Federation International of Gynecology and Obstetrics(FIGO)stage of 130 cases were of≤stageⅡA,and 74 cases were of≥stageⅡB;there were 166 cases of cervical squamous cell carcinoma,38 cases of non-squamous cell carcinoma;there were 58 cases with low/medium differentiation,146 cases with high differentiation.MTD was detected by three-dimensional vaginal ultrasound at the patient′s first diagnosis,and the SCC-Ag level in peripheral blood of the patients before treatment was detected by immunochemiluminescence.The MTD and SCC-Ag levels in peripheral blood of patients with different FIGO stages,tissue types and differentiation degree were compared,and the correlations between MTD,SCC-Ag and cervical cancer FIGO stage,tissue type and differentiation degree were analyzed.The diagnostic efficacy of MTD,SCC-Ag single and in combination for stage≥ⅡB cervical cancer was analyzed by receiver operating characteristic(ROC)curve.Results The SCC-Ag level in peripheral blood of patients in the stage≥ⅡB group was significantly higher than that in the stage≤ⅡA group,and the MTD was significantly larger than that in the stage≤ⅡA group(P<0.05).The SCC-Ag level in peripheral blood of patients in the squamous cell carcinoma group was significantly higher than that in the non-squamous cell carcinoma group(P<0.05).The positive SCC-Ag was 13 patients(34.2%)in the non-squamous cell carcinoma group,111 patients(66.9%)in the squamous cell carcinoma group,and the positive rate of SCC-Ag of patients in the non-squamous cell carcinoma group was signi

关 键 词：宫颈癌 鳞状上皮细胞癌抗原 阴道三维超声 最大肿瘤直径 

分 类 号：R711.74[医药卫生—妇产科学]