查看“RMI”的源代码

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            <strong>恶性肿瘤风险指数</strong>（Risk of Malignancy Index, <strong>RMI</strong>）是妇科临床用于评估盆腔肿块（卵巢囊肿）良恶性风险的经典评分系统。它最早由 Jacobs 等人于 1990 年提出（即 RMI I），随后衍生出多个改良版本。
            <br>RMI 整合了三个关键参数：<strong>血清 [[CA125]] 水平</strong>、<strong>超声特征评分 (U)</strong> 和<strong>绝经状态 (M)</strong>。其核心价值在于“分流”（Triage）：当 RMI 评分高于特定阈值（通常为 200）时，高度提示卵巢癌风险，建议将患者转诊至专业的妇科肿瘤中心进行手术，从而显著改善患者预后；低风险患者则可在普通妇科随访或手术。尽管近年来受到了 [[ROMA指数]] 的挑战，RMI 仍因其计算简便、无需额外检测费用而在临床广泛使用。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">RMI</div>
            <div style="font-size: 0.7em; opacity: 0.85; margin-top: 4px; white-space: nowrap;">恶性肿瘤风险指数 (点击展开)</div>
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                    <span style="font-size: 2em;">🧮</span>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">卵巢癌风险评估模型</div>
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                    <th colspan="2" style="padding: 8px 12px; background-color: #e0f2fe; color: #1e40af; text-align: left; font-size: 0.9em; border-top: 1px solid #bae6fd;">模型参数</th>
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                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">RMI = U × M × CA125</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569; border-bottom: 1px solid #e2e8f0;">CA125</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">血清数值 (U/mL)</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569; border-bottom: 1px solid #e2e8f0;">超声 (U)</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">形态学评分 (0, 1, 3)</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569; border-bottom: 1px solid #e2e8f0;">绝经 (M)</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">状态评分 (1 或 3)</td>
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                    <th colspan="2" style="padding: 8px 12px; background-color: #e0f2fe; color: #1e40af; text-align: left; font-size: 0.9em; border-top: 1px solid #bae6fd;">临床判读</th>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569; border-bottom: 1px solid #e2e8f0;">低风险</th>
                    <td style="padding: 6px 12px; border-bottom: 1px solid #e2e8f0; color: #16a34a;">&lt; 200 (恶性概率 &lt;3%)</td>
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                    <th style="text-align: left; padding: 6px 12px; background-color: #f8fafc; color: #475569;">高风险</th>
                    <td style="padding: 6px 12px; color: #b91c1c;">&ge; 200 (恶性概率 >70%)</td>
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        以最常用的 <strong>RMI I</strong> 为例，其计算逻辑如下：
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            <li style="margin-bottom: 12px;"><strong>U (Ultrasound Score)：超声评分</strong><br>
                观察以下 5 个恶性特征：1) 多房囊肿；2) 实性成分；3) 双侧病变；4) 腹水；5) 腹腔转移灶。<br>
                • 无特征：U = 0<br>
                • 1 个特征：U = 1<br>
                • 2-5 个特征：U = 3
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            <li style="margin-bottom: 12px;"><strong>M (Menopausal Status)：绝经状态</strong><br>
                • 绝经前 (Premenopausal)：M = 1<br>
                • 绝经后 (Postmenopausal)：M = 3 （定义为停经 >1 年或年龄 >50 岁且切除子宫）
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            <li style="margin-bottom: 0;"><strong>CA125：血清学指标</strong><br>
                直接代入血清 CA125 的绝对数值 (U/mL)。
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        <strong>🧮 计算示例：</strong><br>
        一位 55 岁绝经后女性 (M=3)，B超发现伴有实性成分的卵巢肿块 (特征=1, 即 U=1)，CA125 为 100 U/mL。<br>
        <strong>RMI = 1 × 3 × 100 = 300。</strong><br>
        结果 > 200，属于高危组，需高度警惕卵巢癌。
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        随着 HE4 标志物的引入，新的算法 <strong>ROMA (Risk of Ovarian Malignancy Algorithm)</strong> 应运而生。两者孰优孰劣？
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                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">比较维度</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #1e40af; width: 35%;">RMI (经典派)</th>
                <th style="padding: 12px; border: 1px solid #cbd5e1; color: #b91c1c; width: 40%;">ROMA (新锐派)</th>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">参数构成</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">CA125 + 超声 + 绝经</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">CA125 + [[HE4]] + 绝经 (无需超声)</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">早期癌症敏感性</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>较低。</strong><br>I 期卵巢癌 CA125 常不升高，导致漏诊。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>较高。</strong><br>得益于 HE4 在早期卵巢癌中的高表达。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">特异性 (良性鉴别)</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">受内异症干扰大 (CA125 假阳性)。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>更优。</strong><br>HE4 不受内异症影响，能更好排除良性肿块。</td>
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                <td style="padding: 10px; border: 1px solid #cbd5e1; font-weight: 600;">临床便捷性</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;"><strong>极高。</strong><br>无需复杂软件，医生口算即可。</td>
                <td style="padding: 10px; border: 1px solid #cbd5e1;">需特定试剂盒和软件计算。</td>
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        <span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献 [Academic Review]</span>
        
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            [1] <strong>Jacobs I, et al. (1990).</strong> <em>A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer.</em> <strong>[[British Journal of Obstetrics and Gynaecology]]</strong>. <br>
            <span style="color: #475569;">[点评]：RMI 的奠基之作。该研究确立了 RMI I 模型，至今仍被英国 NICE 指南推荐为首选分诊工具。</span>
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            [2] <strong>Tingulstad S, et al. (1996).</strong> <em>Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre-operative diagnosis of pelvic masses.</em> <strong>[[British Journal of Obstetrics and Gynaecology]]</strong>. <br>
            <span style="color: #475569;">[点评]：提出了 RMI II 模型，主要调整了超声评分的权重，试图提高敏感性。</span>
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            [3] <strong>Moore RG, et al. (2009).</strong> <em>Comparison of a novel multiple marker assay vs the Risk of Malignancy Index for the prediction of epithelial ovarian cancer.</em> <strong>[[American Journal of Obstetrics and Gynecology]]</strong>. <br>
            <span style="color: #475569;">[点评]：对比研究显示，ROMA 在绝经前妇女和早期癌症的诊断中优于 RMI，引发了算法迭代的讨论。</span>
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            妇科肿瘤 · 知识图谱
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">上级分类</td>
                <td style="padding: 10px 15px; color: #334155;">[[卵巢癌]] • 临床预测模型</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">核心组件</td>
                <td style="padding: 10px 15px; color: #334155;">[[CA125]] • 经阴道超声 (TVUS)</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle;">替代模型</td>
                <td style="padding: 10px 15px; color: #334155;">[[ROMA指数]] • IOTA 简易法则 (纯超声评估)</td>
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