血清CA125、CA199、CEA及AFP水平检测对卵巢巧克力囊肿诊疗价值的探讨

目的 探讨血清肿瘤抗原125（CA125）、肿瘤抗原199 （CA199）、甲胎蛋白（AFP）及癌胚抗原（CEA）水平对卵巢巧克力囊肿临床的诊断、治疗的价值.方法 回顾性的分析和比较经手术确诊的卵巢巧克力囊肿疾病患者183例（患病组）、卵巢恶性肿瘤患者60例（病例对照组）以及进行健康体检的正常育龄妇女60例（正常对照组）血液中4种肿瘤标记物检测结果,并分析4种指标高低与疾病预后的关系.结果 对照组血清CA125、CA199、AFP及CEA检测值的中位数和阳性率分别为22.55 U/ml、5.2％,19.40 U/ml、11.1％,1.40 ng/mi、0、0.78 ng/ml、0.卵巢巧克力囊肿组血清CA125、CA199、AFP及CEA检测值的中位数及阳性率分别为37.95 U/ml、23.03％,29.67 U/ml、42.41％,1.95 ng/ml、2.14％,0.56 ng/ml、0.轻度（Ⅰ～Ⅱ期）患者血清CA125、CA199、AFP及CEA中位数和阳性率分别为25.25 U/ml、0,20.16 U/ml、23.53％,1.50 U/ml、0和0.58 U/ml、0;中重度（Ⅲ～Ⅳ期）卵巢巧克力囊肿患者血清CA125、CA199、AFP及CEA中位数和阳性率分别为41.55 U/ml、25.31％,31.29 U/ml、44.68％和2.05 U/ml、2.42％,0.56 U/ml、0.卵巢恶性肿瘤CA125、CA199、AFP及CEA检测值的中位数和阳性率分别为188.4 U/ml、81.70％,150.75 U/ml、51.67％,6.9 ng/ml、26.67％,4.40 ng/ml、16.7％.卵巢巧克力囊肿患者血清CA125、CA199和AFP的灵敏度、特异度及正确度分别为23.30％、95％及41.18％,42.41％、90％及55.50％,2.19％、100％及31.5％.卵巢巧克力囊肿患者血清CA125、CA199浓度和阳性率明显高于对照组,差异有统计学意义（均P＜0.05）,AFP的浓度与对照组相比,差异有统计学意义（P＜0.05）,但是阳性率比较差异无统计学意义（P＞0.05）.CEA差异无统计学意义（P＞0.05）.卵巢巧克力囊肿患者血清CA125、CA199、CEA及AFP水平和阳性率血清明显低于恶性卵巢肿瘤组,差异有统计学意义（P＜0.05）.结论 测定血清CA125、CA199水平可协助卵巢巧克力囊肿的诊断、病情判断和指导治疗,二者联合测定可提高疾病诊断敏感性.同时AFP及CEA虽然对于协助卵巢巧克力囊肿的诊断无意义,但是对于鉴别诊断有明显意义.而且CA125和CA199水平是影响卵巢巧克力囊肿预后的因素之一.

Study on diagnostic value and therapeutic value of testing serum CA125,CA199,AFP and CEA levels in patients with endometrialcyst of ovary

Objective To investigate the value of carbohydrate antigen 125 （CA125）,carbohydrate antigen199（CA199）,alpha fetoprotein （AFP） and carcino embryonic antigen （CEA） in the pathogenesis of endometrial cyst of ovary and its clinical potential value.Methods Retrospective analysis and comparison with surgically confirmed ovarian chocolate cyst disease 183 cases （patients group）,60 ovarian cancer patients （casecontrol group） and normal health examination of women of childbearing age of 60 patients （control group） in the blood of four tumor marker test results.Results The median serum levels and poeitive rate of CA125,CA199,AFP and CEA for control group were 5.2％,11.1％,0％ and 0％.The positive rate of CA125,CA199,AFP and CEA and for ovarian chocolate cyst were 23.03％,42.41％,2.14％ and 0％.The median serum levels and positive rate of CA125,CA199,AFP and CEA for malignant ovarian tumor were：81.70％,51.67％,26.67％,16.7％.Mild group （Ⅰ-]period） median serum levels and positive rate of CA125,CA199,AFP and CEA were：25.25 U/ml,0％ ;20.16 U/ml,23.53％ ;1.50 U/ml,0％ and 0.58 U/ml,0％.Severe group （Ⅲ-Ⅳ period） ovarian chocolate cysts serum CA125,CA199,AFP and CEA in the median and the positive rate were：41.55 U/ml,25.31％ ;31.29 U/ml,44.68％ ;2.05 U/ml,2.42％ and 0.56 U/ml,0％.Patients＇,with ovarian chocolate cysts,serum CA125,CA199 and AFP sensitivity,specificity,and accuracy were 23.30％,95％,41.18％ ; 42.41％,90％,55.50％ and 2.19％,100％,31.5％ The serum CA125,CA199,AFP concentration and positive rate was significantly higher in the endometriosis group than that in the control group,the difference was statistically significant （P ＜ 0.05）,the CEA had no significant difference （P ＞ 0.05）.The serum CA125,CA199,CEA and AFP level and positive rate of serum was significantly lower in the patients group than the group of malignant ovarian tumors,and the difference was statistically significant （P ＜ 0.05）.Conclusions Serum CA125 and CA199 levels can assist in the diagnosis of ovarian chocolate cysts,judge of the extent of the disease and guide the treatment,the combination can improve the sensitivity of disease diagnostic.AFP and CEA for assisting the diagnosis of ovarian chocolate cysts are meaningless,but for the differential diagnosis of obvious are meanful.And CA125 and CA199 level is one of the factors which can affect the prognosis of endometriosis.