血清HE4、CA-125和ROMA指数在盆腔恶性肿瘤中的诊断价值

目的探讨血清中人附睾分泌蛋白4(HE4)、糖类抗原125(CA-125)水平和卵巢癌风险预测模型(ROMA)在盆腔恶性肿瘤中的诊断价值。 方法 采用电化学发光免疫测定卵巢癌组、子宫内膜癌组、宫颈癌组、卵巢良性肿瘤组、子宫良性疾病组以及对照组的血清HE4和CA-125水平,并结合绝经状态计算ROMA值。 结果(1)卵巢癌组和子宫内膜癌组血清HE4的表达水平明显高于其它各组(P<0.01); 卵巢癌组血清CA-125的表达水平明显高于除子宫内膜癌组的其它各组(P<0.01); 卵巢良性肿瘤组及子宫良性疾病组血清CA-125的表达水平明显高于对照组(P<0.05)。(2)以卵巢良性肿瘤组为对照组,绝经前HE4对卵巢癌的特异性和阳性预测值高达100%,准确性93.9%,均明显高于CA-125和ROMA值(P<0.01); CA-125对卵巢癌的敏感性最高88.9%,与HE4比较差别有统计学意义(P<0.05)。绝经后三指标在对卵巢癌的特异性、敏感性和准确性上差别无统计学意义(P>0.05)。不考虑绝经与否,HE4的特异性、阳性预测值和准确性最高(98.1%、91.7%和91.4%); ROMA指数的敏感性和阴性预测值最高(81.3%和93.6%)。(3)以卵巢良性肿瘤+健康人为参照人群,HE4、CA-125和ROMA指数单项检测诊断卵巢癌的ROC曲线下面积分别为0.919、0.814和0.921。以子宫良性疾病组为对照组,单独检测HE4在诊断子宫内膜癌的特异性、阳性预期值和准确性方面均明显高于CA-125(P<0.05); HE4与CA-125联合检测子宫内膜癌的敏感性高于单独检测。以子宫良性疾病组+健康人为参照人群,HE4、CA-125单项检测诊断子宫内膜癌的ROC曲线下面积分别为0.916、0.731。 结论 血清HE4对卵巢癌和子宫内膜癌具重要诊断价值,其鉴别诊断效能优于CA-125,且与CA-125联合检测有助于提高子宫内膜癌的诊断率; ROMA指数的应用有助于提高对卵巢癌的诊断效能。

The Diagnostic Value of Serum HE4 and CA-125and ROMA Index in Pelvic Malignant Tumor

Objective To evaluate the value of serum human epididymal secretory protein 4(HE4), carbohydrate antigen 125(CA-125)and the risk of ovarian malignancy algorithm(ROMA)index in the diagnosis of pelvic malignant tumor. Methods HE4,CA-125 level and ROMA index of sera in patients with ovarian cancer, endometrial cancer, cervical cancer, ovarian benign tumor, uterine benign disease and healthy control were detected by electrochemiluminescence immunoassay. Results Serum HE4 levels in both ovarian cancer group and endometrial cancer group were significantly higher than that of other groups(P<0.01). Serum CA-125 level in ovarian cancer group was significantly higher than that of other groups except for endometrial cancer group(P <0.01). Serum CA-125 levels in ovarian benign tumor group and uterine benign disease group were significantly higher than that of healthy control group(P<0.05). With ovarian benign tumor group as a reference to ovarian cancer, both the specificity and positive predictive value of HE4 in premenopausal ovarian cancer group reached up to 100%, and the accuracy was 93.9%, which were significantly higher than that of CA-125 and ROMA(P<0.01). Of three indicators, CA-125 had the highest sensitivity of 88.9%, which significantly higher than that of HE4(P<0.05). However, in post menopause ovarian cancer group, there was no significant difference existed on the specificity, sensitivity and accuracy of three indicators(P>0.05). Regardless of menopause,in three indicators, specificity, positive predictive value and accuracy of HE4 were highest(98.1%, 91.7% and 91.4%)in three indicators, and sensitivity and negative predictive value(81.3% and 93.6%)of ROMA index were highest. With ovarian benign tumor group and healthy control group as a reference to ovarian cancer, the area under ROC curve of HE4, CA-125 and ROMA index was 0.919, 0.814 and 0.921 respectively. With uterine benign disease group as a reference to endometrial cancer, the specificity, positive predictive value and accuracy of HE4 alone were significantly higher than that of CA-125 alone(P<0.05),HE4 and CA-125 combined detection of endometrial cancer sensitivity were higher than single detection. With uterine benign disease group and healthy control group as a reference to endometrial cancer, the area under ROC curve of HE4 and CA-125 was 0.916, 0.731. Conclusion Serum HE4 may be as an important indicator in the diagnosis of ovarian cancer and endometrial cancer, with higher spectivity and accuracy than CA-125, Combining CA-125 could improve the diagnosis of endometrial cancer. ROMA index may be a valuable index contributed to improving the diagnostic efficiency of ovarian cancer greatly.