术前D二聚体在肾嗜酸细胞腺瘤和肾嫌色细胞癌中的鉴别诊断价值  

Differential diagnosis value of D-dimer before operation in renal oncocytoma and chromophobe renal cell carcinoma

作　　者：钱伟伟 徐申 孔琪 Qian Weiwei;Xu Shen;Kong Qi(Department of Urology,Second Hospital of Anhui Medical University,Hefei 230601,China;Department of Radiotherapy,Anhui No.2 Provincial People's Hospital,Hefei 230012,China)

机构地区：[1]安徽医科大学第二附属医院泌尿外科,合肥230601 [2]安徽省第二人民医院肿瘤放疗科,合肥230012

出　　处：《国际肿瘤学杂志》2023年第10期614-617,共4页Journal of International Oncology

基　　金：国家自然科学基金(82204493);安徽医科大学校基金(2021xkj036)。

摘　　要：目的探究术前D二聚体在肾嗜酸细胞腺瘤(RO)和肾嫌色细胞癌(Ch-RCC)鉴别诊断中的应用。方法选取2015年1月至2022年4月安徽医科大学第二附属医院收治的罕少见肾脏肿瘤患者共47例,根据术后病理分为RO组(15例)和Ch-RCC组(32例),对比两组患者一般临床资料及术前血液学指标的差异,通过受试者操作特征(ROC)曲线及曲线下面积(AUC)评估D二聚体对RO和Ch-RCC的鉴别诊断价值。结果Ch-RCC组和RO组患者性别(χ^(2)=0.41,P=0.522)、年龄(t=0.50,P=0.618)、高血压(χ^(2)<0.01,P=0.994)、糖尿病(P=0.541)、吸烟史(χ^(2)=1.67,P=0.196)及肿瘤侧别(χ^(2)=0.67,P=0.414)差异均无统计学意义。Ch-RCC组患者术前D二聚体水平[0.47(0.29,0.77)μg/ml]显著高于RO组[0.21(0.19,0.27)μg/ml],差异具有统计学意义(Z=4.44,P<0.001);两组患者术前血红蛋白(t=-1.61,P=0.116)、血小板(t=0.26,P=0.800)、白细胞(t=0.10,P=0.921)、中性粒细胞(t=-0.87,P=0.390)、淋巴细胞(Z=0.82,P=0.418)、单核细胞(Z=1.43,P=0.153)、中性粒细胞与淋巴细胞比值(Z=0.09,P=0.927)、血小板与淋巴细胞比值(t=0.42,P=0.676)及淋巴细胞与单核细胞比值(Z=-0.96,P=0.338)差异均无统计学意义。ROC曲线分析显示,术前D二聚体临界值为0.78μg/ml时,鉴别诊断RO和Ch-RCC的AUC为0.90(95%CI为0.82~0.99,P<0.001),敏感性为0.78,特异性为1.00。结论Ch-RCC患者术前D二聚体水平明显增高,其对于术前鉴别RO及Ch-RCC具有较高价值。Objective To explore the differential diagnosis value of preoperative D-dimer in renal oncocytoma(RO)and chromophobe renal cell carcinoma(Ch-RCC).Methods From January 2015 to April 2022 in the Second Hospital of Anhui Medical University,clinical data of 47 cases of rare renal tumors were collected.According to postoperative pathology,patients were divided into RO group(15 cases)and Ch-RCC group(32 cases).General clinical data and preoperative blood indicators were analyzed.Receiver operator characteristic(ROC)curve and area under the curve(AUC)were performed to evaluate the differential diagnosis value of D-dimer between RO and Ch-RCC.Results There were no significant differences between two groups in gender(χ^(2)=0.41,P=0.522),age(t=0.50,P=0.618),hypertension(χ^(2)<0.01,P=0.994),diabetes(P=0.541),smoking history(χ^(2)=1.67,P=0.196),tumor laterality(χ^(2)=0.67,P=0.414).Besides,preoperative D-dimer was significantly higher in the Ch-RCC group[0.47(0.29,0.77)μg/ml]in comparison with RO group[0.21(0.19,0.27)μg/ml],with a statistically significant difference(Z=4.44,P<0.001).In addition,there were no significant differences in hemoglobin(t=-1.61,P=0.116),platelet(t=0.26,P=0.800),leucocyte(t=0.10,P=0.921),neutrophil(t=-0.87,P=0.390),lymphocyte(Z=0.82,P=0.418),monocyte(Z=1.43,P=0.153),neutrophil-lymphocyte ratio(Z=0.09,P=0.927),platelet-lymphocyte ratio(t=0.42,P=0.676),and lymphocyte-monocyte ratio(Z=-0.96,P=0.338)between Ch-RCC group and RO group.ROC curve analysis showed that when the cut-off value of preoperative D-dimer was 0.78μg/ml,the AUC for differential diagnosis of RO and Ch-RCC was 0.90(95%CI:0.82-0.99,P<0.001),with a sensitivity of 0.78 and a specificity of 1.00.Conclusion Preoperative level of D-dimer is significantly increased in Ch-RCC patients,which exhibits favourable preoperative differential diagnosis value between Ch-RCC and RO.

关 键 词：纤维蛋白纤维蛋白原降解物 肾肿瘤 诊断 鉴别 

分 类 号：R737.11[医药卫生—肿瘤]