血清人附睾分泌蛋白4、CA125及卵巢癌风险模型在卵巢肿瘤鉴别诊断中的价值

目的探讨血清肿瘤标志物人附睾分泌蛋白4（HE4）、CA125和卵巢癌风险预测模型（ROMA）在卵巢癌鉴别诊断中的应用价值。方法测定卵巢肿瘤患者术前血清HE4和CA125水平,并据此计算每例患者的ROMA指数（PP）。评估CA125、HE4、CA125＋HE4、ROMA指数对卵巢癌的鉴别诊断价值。结果卵巢癌患者血清CA125和HE4水平均显著高于卵巢良性肿瘤患者（均P〈0.01）,Ⅲ、Ⅳ期患者卵巢癌HE4、CA125水平均显著高于Ⅰ、Ⅱ期患者（均P〈0.01）;HE4在上皮性卵巢癌患者血清中的水平显著高于非上皮性恶性肿瘤（P〈0.01）,而CA125无此现象;以卵巢良性肿瘤组为对照,HE4对卵巢癌的诊断灵敏度（78.1%）与CA125（75.0%）相近,但特异度（75.9%）优于CA125（48.1%）;CA125＋HE4联合检测灵敏度高达93.8%,但特异度（50.8%）与CA125单指标相比并无明显改善;ROMA灵敏度（84.4%）、特异度（75.9%）都较高,尤其在浆液性癌和子宫内膜样癌中灵敏度可达100%。结论卵巢肿瘤术前的血清学分析中,单指标分析首选HE4,多指标分析则ROMA优于CA125＋HE4联合检测。

The Differentialdiagnostic Value of HE4,CA125 and the Risk of Ovarian Malignancy Algorithm in Ovarian Tumor

Objective To explore the value with novel tumor maker human epididymis secretory protein 4（HE4） combined with CA125 to validate the predicative model（risks of ovarian malignancy algorithm,ROMA） for discriminating malignant ovarian masses from benign.Methods The serum levels of HE4 and CA125 in women with ovarian masses were measurerd before surgical exploration.Using the analytic results,the ROMA of each patient was calculated and it＇s efficiency of differential diagnosis in ovarian masses was analyzed compared with HE4,CA125 and HE4 ＋ CA125.Results The patients with ovarian cancer（OC） demonstrated higher levels of both biomarkers compared with benign ones（P〈 0.01）.For stage Ⅲ /Ⅳ OC,the serum levels of biomarkers were significantly higher than those in stage Ⅰ/Ⅱ（P〈 0.01）.It＇s noteworthy that HE4 levels in epithelial ovarian cancer（EOC） were significantly higher than that in non-EOC（P 〈0.01）.Setting the benign one as the control,the diagnostic sensitivity of HE4 was 78.1%,being analogous to CA125（75.0%）,while the specificity（75.9%） preceded CA125（48.1%） obviously.The sensitivity of CA125 ＋ HE4 combination attained 93.8%,but the specificity（50.8%） did not show significant increase compared with CA125.The sensitivity/specificity of ROMA was considerably higher（84.4% /75.9%）,especially in serous cystadenocarcinoma and endometrioid carcinoma,in which case the sensitivity attained 100%.Conclusion As serologic biomarks for discriminating malignant ovarian masses from benign preoperatively,HE4 is the first priority as single index,and the ROMA is deemed to be a novel impactful predicative model.