恶性、交界性及良性卵巢肿瘤中生化指标的表达及鉴别诊断价值  

Study on the expression of biochemical indicators and their diagnostic value in malignant,borderline,and benign ovarian tumors

作　　者：崔馨 徐娟[1] 贾雪梅[1] CUI Xin;XU Juan;JIA Xue-mei(Department of Gynecology,Nanjing Medical University Affiliated Obstetrics and Gynecology Hospital(Nanjing Maternal and Child Health Hospital),Nanjing 210004,Jiangsu,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)妇科,江苏南京210004

出　　处：《广东医学》2024年第11期1418-1424,共7页Guangdong Medical Journal

基　　金：江苏省研究生科研创新项目(SJCX22_0670);江苏省重点研发计划(社会发展)项目(BE2020753)。

摘　　要：目的探讨血清生化指标在恶性、交界性和良性卵巢肿瘤中的表达规律及诊断价值,为交界性卵巢肿瘤的术前精准评估提供新的依据。方法对439例卵巢肿瘤患者的临床资料及术前血清生化指标和肿瘤标志物进行回顾性分析,其中恶性组92例,交界性组74例,良性组273例。以病理结果作为“金标准”,分析各指标在恶性、交界性、良性卵巢肿瘤中的表达水平及诊断价值。结果乳酸脱氢酶(lactate dehydrogenase,LDH)、碱性磷酸酶(alkaline phosphatase,ALP)、同型半胱氨酸(homocysteine,Hcy)、白蛋白、总蛋白、视黄醇结合蛋白(retinol binding protein,RBP)、钠和钙等生化指标及HE4、CA125、CA153、CA199等肿瘤学指标在恶性-交界性卵巢肿瘤中差异有统计学意义(P<0.05);LDH、ALP等生化指标及HE4、CA125和CA199等肿瘤学指标在交界性-良性卵巢肿瘤中差异有统计学意义(P<0.05);HE4鉴别恶性-交界性及恶性-良性卵巢肿瘤时的受试者工作特征(ROC)曲线下面积(AUC)均最大。CA125在交界性-良性卵巢肿瘤中鉴别价值最大。LDH、白蛋白和RBP是恶性-交界性卵巢肿瘤诊断价值最大的生化指标(AUC>0.7)。HE4联合ALP和白蛋白在区分恶性-交界性卵巢肿瘤时具有最大的诊断价值(AUC=0.912),CA125联合HE4和ALP在区分交界性-良性卵巢肿瘤时具有最大的诊断价值(AUC=0.841),但联合生化指标并不能提高肿瘤指标单独使用时的AUC。结论多种生化指标在恶性-交界性卵巢肿瘤中存在显著差异,LDH和ALP在交界性-良性卵巢肿瘤中也存在显著差异,提示交界性卵巢肿瘤也会发生一定的代谢改变。但生化指标和肿瘤指标联合并不能提高交界性卵巢肿瘤的鉴别诊断价值。Objective Metabolic abnormalities are key markers of tumors;however,whether borderline ovarian tumors undergo metabolic changes is unclear.This study aims to explore the expression patterns and diagnostic value of serum biochemical indicators in malignant,borderline,and benign ovarian tumors,providing new evidence for the preoperative assessment of borderline ovarian tumors.Methods A retrospective analysis was conducted on the clinical data and preoperative serum biochemical indicators and tumor markers of 439 ovarian tumor patients,including 92 in the malignant group,74 in the borderline group,and 273 in the benign group.Pathological results were used as the“gold standard”to analyze the expression levels and diagnostic value of various indicators.Results Significant statistical differences were found in lactate dehydrogenase(LDH),alkaline phosphatase(ALP),homocysteine(Hcy),albumin,total protein,retinol-binding protein(RBP),sodium,and calcium,as well as HE4,CA125,CA153,and CA199 between malignant and borderline ovarian tumors.Significant differences were also noted in LDH,ALP,and tumor markers(HE4,CA125,CA199)between borderline and benign ovarian tumors.HE4 had the largest area under the ROC curve(AUC)when distinguishing between malignant-borderline and malignant-benign tumors.CA125 showed the greatest diagnostic value in differentiating between borderline and benign tumors.LDH,albumin,and RBP were the most valuable biochemical indicators for diagnosing malignant-borderline ovarian tumors(AUC>0.7).The combination of HE4 with ALP and albumin provided the highest diagnostic value in differentiating malignant from borderline tumors,while CA125 combined with HE4 and ALP had the highest value for borderline versus benign tumors(AUC=0.841).However,combining biochemical indicators did not enhance the AUC compared to using tumor markers alone.Conclusion There are significant differences in various biochemical indicators between malignant and borderline ovarian tumors,and LDH and ALP also show notable differences betw

关 键 词：交界性卵巢肿瘤 鉴别诊断 乳酸脱氢酶 碱性磷酸酶 视黄醇结合蛋白 白蛋白 

分 类 号：R737.31[医药卫生—肿瘤] R711.75[医药卫生—临床医学]