女性盆腔结核与卵巢上皮癌的诊断与鉴别诊断

doi:10.3969/j.issn.2095-3755.2019.01.014

摘要/Abstract

摘要：

目的分析盆腔结核与卵巢上皮癌患者临床表现、影像学和实验室检查资料的差异,提高盆腔结核诊断的准确率。方法收集2013年9月至2018年9月中国医科大学附属盛京医院经病理检查证实为盆腔结核的25例患者作为结核组;同时选择本院同期住院的经过年龄配对的卵巢上皮癌患者25例作为卵巢癌组。对两组患者的临床症状和体征特点、影像学资料和实验室检查结果进行比较和分析。结果结核组患者临床症状中腹痛、腹胀和不孕的发生率分别为40.0%(10/25)、36.0%(9/25)和20.0%(5/25),卵巢癌组的发生率分别为48.0%(12/25)、32.0%(8/25)和0.0%,两组差异均无统计学意义(χ ²值分别为0.33、0.09、3.56,P值分别为0.569、0.765、0.059)。盆腔超声检查结果提示,结核组包块最大径线中位数(四分位数)[M(Q₁,Q₃):6.45(4.70,9.55)cm]短于卵巢癌组[10.60(7.40,15.10)cm],差异有统计学意义(Z=3.08,P=0.002)。正电子发射体层摄影(PET)-CT检查结果显示,结核组包块标准摄取值[M(Q₁,Q₃):8.00(7.72,8.28)]低于卵巢癌组[14.01(12.53,15.17)],差异有统计学意义(Z=1.85,P=0.045)。实验室检查结果显示,结核组人附睾蛋白4(HE4)值[M(Q₁,Q₃):92.84(75.20,102.95)pmol/L]和糖类抗原724值[M(Q₁,Q₃):1.24 (1.10,2.83)kU/L]均低于卵巢癌组[分别为267.38(168.88,489.70)pmol/L和19.43(2.31,50.39)kU/L],差异均有统计学意义(Z值分别为2.06和3.28,P值分别为0.042和0.001)。结论盆腔结核与卵巢癌的主要临床表现均为腹痛、腹胀和不孕;盆腔结核患者包块较卵巢癌患者小,PET-CT包块标准摄取值较卵巢癌患者低,HE4值升高不及卵巢癌患者明显。两种疾病在临床中不易鉴别,必要时需要通过病理检查最终确诊。

关键词: 结核, 女性生殖器, 卵巢肿瘤, 诊断, 鉴别, 对比研究

Abstract:

Objective To analyze the differences in clinical characteristics, imaging feature and laboratory data between patients with pelvic tuberculosis and ovarian cancer in order to improve the accuracy of pelvic tuberculosis diagnosis.Methods A total of 25 patients with pathologically confirmed pelvic tuberculosis in Shengjing Hospital of China Medical University from September 2013 to September 2018 were included as tuberculosis group. During the same period, 25 cases of age-matched ovarian epithelial carcinoma who were hospitalized in the same hospital were included as ovarian cancer group. The clinical symptoms and signs, imaging data and laboratory examination results between the two groups were compared and analyzed.Results The incidence of abdominal pain, abdominal distension and infertility were 40.0% (10/25), 36.0% (9/25) and 20.0% (5/25) in the pelvic tuberculosis group and 48.0% (12/25), 32.0% (8/25) and 0.0% in the ovarian cancer group; there were no significant differences between the two groups (χ ²=0.33, 0.09 and 3.56; P=0.569, 0.765 and 0.059, respectively). Pelvic ultrasound examination of patients indicated that the maximum diameter of mass in the pelvic tuberculosis group (median (quartile), M(Q₁,Q₃): 6.45 (4.70, 9.55)cm) was shorter than that in the ovarian cancer group (10.60 (7.40, 15.10)cm); the difference was statistically significant (Z=3.08, P=0.002). The positron emission tomography-computed tomography (PET-CT) showed that standard uptake value (SUV) of mass in the pelvic tuberculosis group (M(Q₁,Q₃): 8.00 (7.72, 8.28)) was lower than that of the ovarian cancer group (14.01 (12.53, 15.17)); the difference was statistically significant (Z=1.85, P=0.045). Laboratory examination results showed that human epididymis protein 4 (HE4) (M(Q₁,Q₃): 92.84 (75.20, 102.95)pmol/L) and carbohydrate antigen 724 values ( $M (Q 1, Q 3$ ): 1.24 (1.10, 2.83)kU/L) of the pelvic tuberculosis group were lower than those of the ovarian cancer group (267.38 (168.88, 489.70)pmol/L and 19.43 (2.31, 50.39)kU/L); the differences were statistically significant (Z=2.06 and 3.28, P=0.042 and 0.001, respectively).Conclusion The main clinical manifestations of pelvic tuberculosis and ovarian cancer were abdominal pain, abdominal distension and infertility. Pelvic mass in the pelvic tuberculosis patients was smaller compared with ovarian cancer patients. The SUV of mass indicated by PET-CT in the pelvic tuberculosis patients was lower compared with ovarian cancer patients. The increased HE4 value in the pelvic tuberculosis patients was not as significant as the ovarian cancer patients. It is difficult to diffe-rentiate pelvic tuberculosis and ovarian cancer in clinic. Pathological examination is required when necessary.

Key words: Tuberculosis, female genital, Ovarian neoplasms, Diagnosis, differential, Comparative study

李妍,张慧玲,欧阳玲. 女性盆腔结核与卵巢上皮癌的诊断与鉴别诊断[J]. 结核病与肺部健康杂志, 2019, 8(1): 60-64. doi: 10.3969/j.issn.2095-3755.2019.01.014

Yan LI,Hui-ling ZHANG,Ling. OU-YANG. Diagnosis and differentiation of female pelvic tuberculosis and ovarian cancer[J]. Journal of Tuberculosis and Lung Health, 2019, 8(1): 60-64. doi: 10.3969/j.issn.2095-3755.2019.01.014

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参考文献 14

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一般资料	结核组(25例)	卵巢癌组(25例)	Z值	P值
体质量[kg,M(Q₁,Q₃)]	58.00(50.00,65.00)	60.00(55.00,65.00)	0.68	0.501
孕次[次,M(Q₁,Q₃)]	2.00(1.00,2.00)	2.00(1.00,2.00)	0.57	0.576
产次[次,M(Q₁,Q₃)]	1.00(0.00,1.00)	1.00(0.00,1.00)	0.20	0.854

临床表现	结核组(25例)	卵巢癌组(25例)	χ²值	P值
症状
腹痛	10(40.0)	12(48.0)	0.33	0.569
腹胀	9(36.0)	8(32.0)	0.09	0.765
体质量减轻	7(28.0)	5(20.0)	0.44	0.508
不孕^a	5(20.0)	0(0.0)	3.56	0.059
发热^a	5(20.0)	2(8.0)	0.66	0.415
体征^b
附件区包块	14(66.7)	16(84.2)	1.64	0.201
包块活动性差	6(28.6)	8(42.1)	0.80	0.370
包块压痛	5(23.8)	6(31.6)	0.30	0.583

检查项目	结核组	卵巢癌组	统计检验值	P值
胸部CT
胸腔积液[例(发现率,%)]^a	78.6(11/14)	33.3(4/12)	χ²=3.72	0.054
肺内结节[例(发现率,%)]^a	28.6(4/14)	0.0(0/12)	χ²=2.15	0.142
盆腔超声
肿物血流丰富[例(发现率,%)]^a	0.0(0/25)	16.0(4/25)	χ²=2.45	0.118
囊肿附壁回声团[例(发现率,%)]^a	0.0(0/25)	20.0(5/25)	χ²=3.56	0.059
腹腔积液[例(发现率,%)]	52.0(13/25)	44.0(11/25)	χ²=0.32	0.571
腹腔积液深度[cm,M(Q₁,Q₃)]^b	4.80(3.80,8.00)	3.10(2.15,6.00)	Z=1.24	0.221
包块最大径线[cm,M(Q₁,Q₃)]^b	6.45(4.70,9.55)	10.60(7.40,15.10)	Z=3.08	0.002
全腹CT
腹膜增厚[例(发现率,%)]^a	27.8(5/18)	7.1(1/14)	χ²=1.06	0.304
肠系膜淋巴结肿大[例(发现率,%)]^a	33.3(6/18)	0.0(0/14)	χ²=3.76	0.052
PET-CT
恶性伴转移[例(发现率,%)]^a	100.0(4/4)	83.3(5/6)	χ²=0.00	1.000
标准摄取值(SUV)[M(Q₁,Q₃)]^b	8.00(7.72,8.28)	14.01(12.53,15.17)	Z=1.85	0.045

检测指标	结核组		卵巢癌组		Z值	P值
检测指标	例数	检测结果[M(Q₁,Q₃)]	例数	检测结果[M(Q₁,Q₃)]	Z值	P值
白细胞计数(×10⁹/L)	25	6.33(5.45,7.00)	25	7.86(6.41,9.13)	2.02	0.054
中性粒细胞	25	0.68(0.62,0.75)	25	0.72(0.65,0.76)	1.09	0.287
CRP(mg/L)	6	77.10(28.05,115.43)	2	23.20(22.35,24.05)	0.50	0.641
ESR(mm/1h)	10	49.50(18.75,69.75)	0	-	-	-
腹腔积液腺苷脱氨酶(U/L)	4	80.26(52.35,121.58)	0	-	-	-
CA125(kU/L)	23	278.70(113.10,363.95)	23	192.80(46.59,1116.50)	0.54	0.593
HE4(pmol/L)	4	92.84(75.20,102.95)	12	267.38(168.88,489.70)	2.06	0.042
CA724(kU/L)	15	1.24(1.10,2.83)	19	19.43(2.31,50.39)	3.28	0.001

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