中国实用口腔科杂志

中国实用口腔科杂志

• 论著 • 上一篇    下一篇

甲苯胺蓝染色在口腔潜在恶性疾患及口腔鳞状细胞癌早期诊断中的临床应用价值研究

王倩1，徐偲2，韩莹1，金建秋3，程喆1，刘晓丹1，赵忠芳1，崔红梅1，李文文1，郭骧1，王兴1，
鲁明星1，刘宏伟1   

  1. 1.北京大学口腔医院口腔黏膜科，北京 100081；2.首都医科大学附属北京朝阳医院口腔科，北京 100020；3.北京医院口腔科，北京 100050
  • 出版日期:2020-12-15 发布日期:2021-02-09
  • 基金资助:
    国家自然科学基金（81771071）；国家卫生健康委公益性行业专项（201502018）

  • Online:2020-12-15 Published:2021-02-09

摘要： 目的　综合评价甲苯胺蓝染色在口腔潜在恶性疾患（oral potential malignant disorders，OPMDs）及口腔鳞状细胞癌（oral squamous cell carcinoma，OSCC）早期诊断中的临床应用价值。方法　选取2016年8月至2018年5月于北京大学口腔医院口腔黏膜科就诊的OPMDs及OSCC患者533例。对所有患者进行临床检查、甲苯胺蓝染色和组织病理学检查。以组织病理学诊断为金标准，评价甲苯胺蓝染色的灵敏度、特异度和准确度；绘制受试者工作特征曲线（receiver operator characteristic curve，ROC）及计算曲线下面积（area under curve，AUC），评价甲苯胺蓝染色的诊断价值；并对上皮异常增生或OSCC的影响因素进行logistic回归分析。结果　甲苯胺蓝染色诊断上皮异常增生或OSCC的灵敏度为75.32%，特异度为84.17%，准确度为81.61%；诊断OSCC的灵敏度为97.10%，特异度为76.51%，准确度为79.17%；诊断上皮异常增生的灵敏度为57.65%，特异度为84.17%，准确度为79.31%。随着上皮异常增生程度的加重，甲苯胺蓝染色诊断的灵敏度越高；且甲苯胺蓝染色诊断轻、中度上皮异常增生的灵敏度均高于临床危险度诊断，其差异均有统计学意义（均P < 0.05）。ROC曲线分析，甲苯胺蓝染色诊断上皮异常增生或OSCC的AUC值为0.797，高于临床危险度诊断的AUC值（0.721）；甲苯胺蓝染色诊断OSCC的AUC值为0.868，高于临床危险度诊断的AUC值（0.802）。logistics回归分析发现，年龄、病程、活检病损部位、临床危险度和甲苯胺蓝染色均与上皮异常增生或OSCC显著相关，甲苯胺蓝染色阳性者患有上皮异常增生或OSCC的风险是甲苯胺蓝染色阴性的13.655倍。结论　综合多项指标评估结果，甲苯胺蓝染色是一种诊断效力强的无创辅助检查技术，推荐应用于OPMDs及OSCC的早期诊断。

关键词: 甲苯胺蓝染色, 口腔潜在恶性疾患, 口腔鳞状细胞癌, logistic回归分析, 受试者工作特征曲线

Abstract: Objective　To evaluate the clinical value of toluidine blue staining in early diagnosis of oral potential malignant disorders（OPMDs）and oral squamous cell carcinoma（OSCC）. Methods　A total of 533 OPMDs and OSCC patients admitted to the Department of Oral Mucosa of Peking University Hospital of Stomatology from August 2016 to May 2018 were selected. Clinical examination，toluidine blue staining and histopathological examination were performed on all patients. Histopathological diagnosis was used as the gold standard to evaluate the sensitivity，specificity and accuracy of toluidine blue staining. Draw receiver operator characteristic curve（ROC）and calculate area under curve（AUC）to evaluate the diagnostic value of toluidine blue staining. Logistic regression analysis was performed on the influencing factors of epithelial dysplasia or OSCC. Results　The sensitivity，specificity and accuracy of toluidine blue staining were 75.32%，84.17% and 81.61%，respectively，in the diagnosis of epithelial dysplasia or OSCC. The sensitivity，specificity and accuracy of toluidine blue staining for OSCC were 97.10%，76.51% and 79.17% respectively. The sensitivity，specificity and accuracy of toluidine blue staining in the diagnosis of epithelial dysplasia were 57.65%，84.17% and 79.31% respectively. With the aggravation of the degree of epithelial dysplasia，the sensitivity of toluidine blue staining was higher. The sensitivity of toluidine blue staining in the diagnosis of mild and moderate epithelial dysplasia was higher than that in the diagnosis of clinical risk，and the difference was statistically significant （P < 0.05）. ROC curve analysis showed that toluidine blue staining in diagnosing epithelial dysplasia or OSCC had an AUC value of 0.797，which was higher than the AUC value of clinical classification risk （0.721）. The AUC value of toluidine blue staining for OSCC diagnosis was 0.868，which was higher than the AUC value of clinical classification risk （0.802）. Logistics regression analysis found that age，disease course，biopsy lesion site，clinical risk and toluidine blue staining were all significantly correlated with epithelial dysplasia or OSCC，and the risk of epithelial dysplasia or OSCC in toluidine blue staining positive patients was 13.655 times that of toluidine blue staining negative patients. Conclusion　Based on the evaluation results of multiple indicators，it is known that toluidine blue staining is a non-invasive auxiliary examination technique with strong diagnostic power. It is recommended for clinical application in early diagnosis of OPMDs and OSCC.

Key words: toluidine blue staining；oral potential malignant disorders, OPMDs；oral squamous cell carcinoma, OSCC；logistic regression analysis；receiver operating characteristic curve, ROC