多模态超声联合血清标志物对早期子宫内膜样癌肌层浸润深度的诊断效能分析  

Efficacy of cognitive-behavioral therapy combined with estazolam for insomnia patients with anxiety

作　　者：张昌红 叶玲红[1] 黄岩花[1] ZHANG Changhong;YE Linghong;HUANG Yanhua(Department of Ultrasound Medicine,Lishui Central Hospital(the Fifth Affiliated Hospital of Wenzhou Medical University),Lishui 323000,China;不详)

机构地区：[1]丽水市中心医院(温州医科大学附属第五医院)超声医学科,323000

出　　处：《浙江医学》2025年第1期47-52,共6页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF20H180018)。

摘　　要：目的探讨多模态超声联合血清标志物对早期子宫内膜样癌(EEC)肌层浸润深度的诊断效能。方法回顾性选取2021年1月至2023年1月丽水市中心医院收治的经术后组织病理学检查诊断为早期EEC患者90例,根据组织病理学诊断的肌层浸润深度将患者分为<1/2肌层浸润组(浅或无肌层浸润)49例,≥1/2肌层浸润组(深肌层浸润)41例。患者均行多项超声检查和血清标志物检查。分析经阴道彩色多普勒超声(TVCDS)、三维能量多普勒超声(3D-PDA)、超声造影(CEUS)及多模态超声(联合应用TVCDS、3D-PDA及CEUS)诊断EEC肌层浸润深度的准确率;比较两组患者血清标志物甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA125)、糖类抗原72-4(CA72-4)、人附睾蛋白4(HE4)水平;比较两组患者超声定量参数子宫内膜容积(EV)、血流指数(FI)以及血管形成指数(VI)和血管形成-血流指数(VFI)、血流阻力指数(RI)、脉搏指数(PI)、上升时间(RT)、达峰时间(TTP)、峰值强度;分析多模态超声联合血清标志物对早期EEC肌层浸润深度的诊断效能。结果以病理学检查结果为金标准,TVCDS、3D-PDA、CEUS及多模态超声诊断EEC肌层浸润深度的准确率分别为64.4%、70.0%、78.9%、82.2%。两组患者血清AFP、CEA、CA72-4表达水平比较差异均无统计学意义(均P>0.05)。≥1/2肌层浸润组患者血清CA19-9、CA125、HE4表达水平高于<1/2肌层浸润组(均P<0.05)。≥1/2肌层浸润组患者EV、FI、VI、VFI、峰值强度均大于<1/2肌层浸润组(均P<0.05),而PI、RI、RT、TTP均小于<1/2肌层浸润组(均P<0.05)。ROC曲线分析显示,多模态超声、血清CA19-9、CA125、HE4及联合应用诊断EEC肌层浸润深度的AUC分别为0.821、0.656、0.808、0.745、0.932;灵敏度分别为0.805、0.561、0.805、0.756、0.854;特异度分别为0.837、0.796、0.714、0.694、0.980;血清CA19-9、CA125、HE4诊断EEC肌层浸润深度的最佳截断值分别为21.Objective To investigate the efficacy of multimodal ultrasonography combined with serum tumor markers for assessing the depth of myometrial infiltration in patients with early endometrioid carcinoma(EEC).Methods A total of 90 patients with EEC diagnosed by histopathology admitted in the Lishui Central Hospital from January 2021 to January 2023 were included.There were 49 cases with myoinfiltration<1/2 or no myoinfiltration and 41 cases with myoinfiltration≥1/2.All patients underwent transvaginal color Doppler ultrasound(TVCDS),three-dimensional power-Doppler ultrasound(3DPDA)and contrast-enhanced ultrasound(CEUS)examination.The serum tumor markers AFP,CEA,CA19-9,CA125,CA72-4 and HE4 were measured.The ultrasound quantitative parameters endometrial volume(EV),flow index(FI),vascularization index(VI),vascularization-flow index(VFI),blood flow resistance index(RI),pulse index(PI),rise time(RT),time to peak(TTP)and peak intensity(PI);and serum levels of tumor markers were compared between two groups of patients.The efficacy of multimodal ultrasound parameters and serum tomor markers levels,and in combination of both for assessing myometrial infiltration depth in EEC patients were analyzed.Results The accuracy of TVCDS,3DPDA,CEUS and multimodal ultrasound in diagnosing the depth of EEC muscle infiltration were 64.4%,70.0%,78.9%and 82.2%,respectively.There were no significant differences in serum levels of AFP,CEA and CA72-4 between two groups(all P>0.05).Serum levels of CA19-9,CA125 and HE4 in≥1/2 myoinfiltration group were higher than those in<1/2 myoinfiltration group(all P<0.05).EV,FI,VI,VFI and PI in≥1/2 myoinfiltration group were all higher than those in<1/2 myoinfiltration group(all P<0.05),while PI,RI,RT and TTP were all lower than those in<1/2 myoinfiltration group(all P<0.05).ROC curve analysis showed that the AUC of multimodal ultrasound,serum CA19-9,CA125,HE4 and combination of multimodel ultrasound and serum tumor markers in assessting EEC myographic infiltration depth were 0.821,0.656,0.808,0.745 and

关 键 词：超声检查 能量多普勒 三维 超声造影 定量分析 人附睾分泌蛋白4 糖类抗原125 糖类抗原19-9 子宫内膜样癌 

分 类 号：R737.33[医药卫生—肿瘤]