CA19-9、CA125和CP2在卵巢黏液性肿瘤诊断和监测中的价值

目的探讨血清肿瘤标志物CA19-9、CA125及CP2在卵巢黏液性肿瘤诊断和监测中的价值。方法对北京大学人民医院1999年1月至2007年6月间收治的273例卵巢肿瘤患者的临床资料进行回顾性分析,探讨血清肿瘤标志物CA19-9、CA125及CP2在50例卵巢黏液性肿瘤诊断和监测中的价值,并与223例卵巢非黏液性肿瘤进行比较。结果（1）卵巢黏液性肿瘤中,CA19-9的曲线下面积最大（为0．95）,其次是CA125（为0．90）;而卵巢非黏液肿瘤中,CA125和CP2的曲线下面积最大（均为0．90）。（2）卵巢黏液性肿瘤患者联合检测CA19-9和CA125时,其敏感度（93．8％）较单项检测（CA19-9和CA125分别为75．0％和66．7％）明显提高（P〈0．05）,而特异度（分别为86．1％、86．6％和90．2％）无明显变化（P〉0．05）。卵巢非黏液性肿瘤患者联合检测CA125和CP2时的敏感度（85．0％）,较CP2（70．6％）单项检测明显提高,差异有统计学意义（P〈0．05）;较CA125（80．7％）单项检测虽有提高,但差异无统计学意义（P〉0．05）;3者的特异度（分别为90．2％、88．5％和93．9％）比较,差异无统计学意义（P〉0．05）。（3）82例卵巢恶性肿瘤术前血清肿瘤标志物阳性患者中。可行满意的肿瘤细胞减灭术患者[70％（57／82）]的血清肿瘤标志物于术后2个月内降为正常的百分率高于未能行满意肿瘤细胞减灭术者（分别为75％和28％）,差异有统计学意义（P〈0．05）;且其术后血清肿瘤标志物再次上升的平均时间延长（分别为18．2和16．4个月）,但差异无统计学意义（P〉0．05）;复发率（分别为35％和56％）及死亡率（分别为14％和32％）降低,差异有统计学意义（P〈0．05）。20例术前血清肿瘤标志物阴性患者均可行满意的肿瘤细胞减灭术,其中复发患者仅2例（10％）。（4）卵巢黏液性肿瘤患者术后复发时多为血清CA19-9水平上升,而卵巢非黏液性肿瘤术后复发时主要为血清CA125水平上升,部分患者血清CP2水平也上升。（5）术前血清肿瘤标志物阳性患者较阴性患者生存率明显下降,其中CA125（＋）与CA125（-）、CP2（＋）与CP2（-）患者间生存率比较,差异有统计学意义（P〈0．05）;而CA19-9（＋）与CA19-9（-）患者间生存率比较,差异则无统计学意义（P〉0．05）。结论CA19-9是诊断卵巢黏液性肿瘤的敏感指标,与CA125联合检测可提高对卵巢黏液性肿瘤诊断的敏感度,并对术后监测有重要临床意义。CA125和CP2联合检测则对诊断卵巢非黏液肿瘤更敏感。     

卵巢上皮性癌患者术前血清血管内皮生长因子与CA125水平的相关性及其预测预后的价值

目的分析卵巢上皮性癌（卵巢癌）患者术前血清血管内皮生长因子（VEGF）与CA125水平的相关性,探讨术前血清VEGF水平在卵巢癌患者预后判断中的价值。方法采用酶联免疫吸附试验（EHSA）测定41例卵巢癌患者（研究组）库存的术前血清中VEGF的水平,采用化学发光法测定同一份血清的CA125水平;以同期20例盆腔检查正常的妇女作为对照组。结合随诊资料,分析卵巢癌患者术前血清VEGF水平与CA125水平的相关性,并分析术前血清VEGF水平与患者复发和生存时间的关系。结果（1）研究组术前血清VEGF和CA125水平均明显高于对照组（VEGF中位数分别为415和165ng／L,CA125分别为611和16kU／L）,差异均有统计学意义（P〈0．01）;（2）Spearman等级相关分析显示,卵巢癌患者术前血清VEGF水平与血清CA125水平间无明显相关性（P=0．989）;（3）卵巢癌患者术前血清VEGF水平与其复发相关,复发者术前VEGF水平明显高于无复发者（中位数分别为490和315ng／L,P=0．035）;（4）单因素Kaplan-Meier法分析显示,卵巢癌患者术前血清VEGF水平与其生存时间呈负相关,高血清VEGF水平者的生存时间明显短于低血清VEGF水平者（中位数生存时间分别为18个月和〉35个月,P=0．010）;（5）多因素Cox回归模型分析显示,卵巢癌患者术前血清VEGF水平是与其生存时间有关的独立预后因素（P=0．042）。结论卵巢癌患者术前血清VEGF水平与CA125水平无明显相关性,VEGF水平变化是影响患者预后的独立因素。     

CA125对子宫内膜癌检测及临床意义

目的 探讨血清CA25值对子宫内膜癌早期诊断、监测病情变化和预测预后的价值。方法 用免疫化学法检测55例子宫内膜癌患者和16例良性子宫病变患者血清CA125水平。结果 良性子宫病变和44例手术分期为I期的子宫内膜癌患者血清CA125阳性率分别为19．4％和27．3％，两者相比，P＞0．05，无显著性差异（P＞0．05）。手术分期为I期和10例晚期病人（Ⅲ期＋Ⅳ期）血清CA125的阳性率各为27．3％和70％，两者相比，有显著性差异（P＜0．05）。30例Ia期＋Ib期和14例Ic期病人血清CA1254的阳性率分别为20％和47．8％，两者相比，无显著性差异（P＞0．05）。病理分级中30例G1、20例G2、5例G3血清CA1254的阳性率分别为20％、45％、80％，三者相比，相互之间有显著性差异（P＜0．05）。结论 血清CA125的检测对早期诊断子宫内膜癌缺乏敏感性，对早期内膜癌患者预测手术分期，Ic期无明显的参考价值，但与手术分期和病理分级密切相关，可能对预测预后提供一定的参考价值。     

子宫内膜癌患者血清CP2、CA125、唾液酸和癌胚抗原检测的临床意义

目的探讨肿瘤标志物CP2、CA125、唾液酸（SA）和癌胚抗原（CEA）检测对子宫内膜癌患者的临床意义。方法选取154例具有肿瘤标志物检测结果的子宫内膜癌患者的临床病理资料进行回顾性分析。结果子宫内膜癌患者血清CP2、SA、CA125和CEA水平升高的百分率分别为23．4％、36．8％、19．0％和30．3％。血清CP2水平升高与手术病理分期、病理分化程度、附件受累、腹腔细胞学检查阳性及盆腔淋巴结转移相关（P值分别为0．002、0．040、0．019、0．019、0．005）;血清SA水平升高与附件受累、腹腔细胞学检查阳性相关（P值分别为0．021、0．000）;血清CA125水平升高与病理分化程度、宫颈受累和盆腔淋巴结转移相关（P值分别为0．014、0．006、0．018）;CEA与各临床病理特征间均无相关性（P均〉0．05）。血清CP2、CA125和CEA水平升高与患者预后相关（P值分别为0．016、0．000、0．016）,其中CA125水平与预后关系最为密切。结论子宫内膜癌缺乏特异性肿瘤标志物,CP2与子宫内膜癌临床病理特征相关性较强,CP2、CA125和CEA对患者预后有提示作用。     

卵巢上皮性癌新辅助化疗后血清CA125水平下降至一半所需的时间与手术切净率及预后的关系

目的 探讨卵巢上皮性癌新辅助化疗后血清CA125,水平下降至一半所需的时间（即CA15的T1/2）与手术切净率及预后的关系。方法 回顾性分析39例行新辅助化疗的卵巢上皮性癌患者,以化疗后CA125的T1/2长短分组,分为T1/2〈20d组和T1/2≥20d组,比较两组间的手术切净率及预后。结果 新辅助化疗后T1/2≥120d组的手术切净率明显低于T1/2〈20d组（分别为29％和80％,P〈0．01）。T1/2≥20d组的中位生存时间为21.2个月,明显低于T1/2〈20d组的37．6个月（P〈0．05）;两组累计生存率比较,差异有统计学意义（P〈0．01）。多因素分析提示,血清CA125的T1/2及术后残留灶直径是卵巢上皮性癌患者新辅助化疗后影响其预后的独立因素。结论 卵巢上皮性癌新辅助化疗后,血清CA125的T1/2长短有助于术前判断手术切净情况,并且是影响此类患者预后的独立因素。     

血清CA125与抗子宫内膜抗体联合测定对子宫内膜异位症的诊断价值

目的 探讨血清CA125与抗子宫内膜抗体联合测定对于宫内膜异位症诊断的临床价值。方法 应用放射免疫法及酶联免疫吸附试验（ELISA）法测定44例子宫内膜异位症患者（EMT组）血清中CA125值及EMAb阳性情况，并与40例健康妇女对照组进行比较。结果 EMT组血清CA125值阳性率为61．4％（27／44），显著高于对照组5．0％（2／40），P〈0．05；EMT组抗子宫内膜抗体阳性率为65．9％（29／44），显著高于对照组7．5％（3／40），P〈0．05；联合测定EMT患者血清CA125值及抗子宫内膜抗体，其敏感性明显高于两者单独测定的敏感性。结论 血清CA125与抗子宫内膜抗体联合测定可提高子宫内膜异位症诊断的敏感性。     

IL—6、CRP、CA125在卵巢肿瘤定位诊断中的价值及临床意义

目的：探讨测定血清IL－6、CRP、CA125水平在卵巢肿瘤定性诊断中的价值及临床意义。方法：取卵巢肿瘤61例患者的血浆及17例合并腹水患者的腹水，用ELISA法及胶乳凝集法测定IL－6、CA125、CRP。结果：IL－6诊断卵巢癌敏感性为80．9％，特异性为77．3％。CA125诊断卵巢癌敏感性为85．7％，特异性为80．9％。这二项指标联合检测，敏感性为92．5％，特异性73．9％。CRP诊断卵巢癌敏感性高达76．2％，特异性60．0％。临床分期晚、组织分化低者血清及腹水IL－6、CA125水平明显升高。结论：IL－6、CA125是卵巢肿瘤定性诊断的良好指标，联合检测可提高定性诊断的敏感性及特异性。腹水或血中IL－6、CA125水平可为卵巢癌早期诊断、分期及判断预后提供有效的参考指标。     

CA125、CA19．9、CEA在卵巢上皮性交界性肿瘤中的临床价值

目的：探讨测定血清CA125、CA19．9、CEA在诊断卵巢上皮性交界性肿瘤中的临床价值。方法：回顾分析卵巢交界性肿瘤50例血清CA125、CA19．9、CEA水平与临床资料。结果：浆液性及粘液性肿瘤中CA125的阳性率分别为53．85％和60％，差异无显著性（P＞0．05），临床分期晚者CA125阳性率有增高趋势；粘液性肿瘤中CA19．9的阳性率为43．75％；CEA阳性率为12％，仅见于粘液性或以粘液性为主的肿瘤中；与术前相比，术后CA125、CA19．9水平及阳性率均显著下降（P＜0．05）。结论：CA125、CA19．9对卵巢上皮性交界性肿瘤的术前诊断及疗效监测有一定价值，CEA则在鉴别组织学类型中有一定价值。     

对子宫腺肌病患者血清CA125及EMAb的临床评价

目的：探讨血清CA125及子宫内膜抗体（EMAb)测定，对子宫腺肌病的诊断及疗效评估的临床价值。方法：经术后病理学检查确诊子宫腺肌病患者63例和子宫肌瘤患者45例，均于术前及术后测定两组血清CA125水平和EMAb。结果：子宫腺肌病组术前血清CA125平均水平及EMAb阳性率均高于子宫肌瘤组，两者相比差异有显著性（P＜0．001及P＜0．01）。联合测定血清CA125水平和EMAb，以两者均阳性为诊断标准，诊断子宫腺肌病的敏感性为54．63％，特异性为100％。子宫腺肌病组术后血清CA125水平和EMAb阳性率均较术前下降，差异有显著性（P＜0．01及P＜0．05）。结论：测定血清CA125及EMAb对子宫腺肌病有较好的辅助诊断价值，联合检测更能提高诊断的正确性，并可作为评价子宫腺肌病疗效的敏感指标。     

子宫颈鳞状细胞癌复发患者血清鳞状细胞癌抗原监测的意义

目的探讨血清鳞状细胞癌抗原（SCCAg）在监测宫颈鳞癌患者复发中的意义。方法对1999-2005年收治的72例宫颈鳞癌复发患者血清SCCAg水平与诊断、预后的关系进行单因素和多因素分析。结果72例复发患者中,术后复发30例、放化疗后复发42例,其中血清SCCAg水平升高者61例（占85％）。此61例患者中,20例在随诊中首先出现血清SCCAg水平升高而临床及影像学检查未发现肿瘤,血清SCCAg水平提前升高的中位时间为3个月,平均4．6个月（1～13个月）。72例复发患者中,45例患者无任何临床症状,仅因血清SCCAg水平升高或常规随诊发现复发;27例患者有症状,其中单侧下肢水肿或疼痛15例,阴道不规则流血7例,出现远处转移相关症状5例。细胞或组织病理学检查诊断复发者33例;临床及影像学检查结合血清SCCAg水平诊断复发者39例,其中29例仅依靠血清SCCAg水平升高及影像学检查即诊断复发。72例复发患者的中位生存时间为11个月,平均生存时间为23个月（2～62个月）,总的3年生存率为25％,5年生存率为19％。单因素分析发现,初治前患者血清SCCAg水平、病理分级、复发部位、复发后治疗方式以及复发时、复发后治疗中、治疗后血清SCCAg水平对患者的3年生存率有明显影响（P〈0．01）;但20例血清SCCAg水平提前出现升高的患者与52例血清SCCAg水平未提前升高的患者相比,3年生存率分别为22％、27％,差异无统计学意义（P=0．5761）。多因素分析发现,复发患者仅病理分级、复发后的治疗方式是独立的预后影响因素（P〈0．05）;而复发部位及各种血清SCCAg状态不是独立的预后影响因素（P〉0．05）。结论血清SCCAg水平监测在宫颈鳞癌复发患者中的诊断及其对预后的判断中有一定的价值。     

Potential Clinical Utility of CA-125 in Responsive but Persistent Large-Volume Ovarian Cancer Following Platinum-Based Chemotherapy:

BACKGROUND: Despite the demonstrated clinical utility of the serum CA-125 antigen level in ovarian cancer, controversy exists regarding interpretation of "discordant" results between changes in this tumor marker and measurable disease masses. CASE: A patient with ovarian cancer cared for in the Gynecologic Cancer Program of the Cleveland Clinic Foundation receiving second-line single-agent carboplatin for recurrent disease demonstrated a major response in serum CA-125, but minimal shrinkage of a large painful abdominal mass. A laparotomy was performed both to define the nature of this mass and to attempt to relieve symptoms. The mass was found to be a large "inflamed pseudotumor with central necrosis." No viable tumors cells were found. CONCLUSION: This case represents an excellent example of the remarkably complex biology of malignant disease and suggests how evaluation of changes in CA-125 in women with ovarian cancer may be utilized in individual patients to develop optimal management plans.     

HuR expression in the nucleus correlates with high histological grade and poor disease-free survival in ovarian cancer

Background: HuR, a nucleo-cytoplasmic shuttling protein, plays an important role in mRNA stability as well as cellular differentiation. Recently, HuR expression, particularly in the cytoplasm, was thought to be associated with the prognosis of several cancers including ovarian cancer.
Aims: To study the clinical significance of nuclear HuR expression in ovarian cancer.
Methods: Primary epithelial ovarian carcinomas (102) and ovarian low malignant potential tumours (11) were assessed for HuR protein expression by immunohistochemistry. HuR scoring accounted for both intensity and percentage of cells stained, and ranged from 0 to 300.
Results: HuR was found to be present predominantly in the nucleus, where it was expressed in 85.8% of cases. Nuclear HuR was associated with the invasive cancers ( P  = 0.004), high grade ( P  < 0.0001), large residual disease ( P  = 0.045) and poor disease-free survival ( P  = 0.0009). Among those 91 specimens with high grade, 76.9% had a high nuclear HuR score, while in those 22 cases with low grade, only 31.8% had a high HuR score ( P  < 0.0001). Multivariate analysis showed that nuclear HuR intensity was an independent prognostic factor for poor disease-free survival ( P  = 0.0484). When the invasive cancers were analysed separately, only the association between nuclear HuR and high grade remained ( P  = 0.0089).
Conclusions: Our results support the clinical significance of nuclear HuR in ovarian carcinoma and suggest that nuclear HuR may also play a role in the biology of ovarian cancer. These data suggest a more complex model for HuR in ovarian cancer than one limited to cytoplasmic localisation.     

胰岛素样生长因子及其结合蛋白对体外精子活力的影响

精浆中含有胰岛素样生长因子（ＩＧＦｓ）、ＩＧＦ结合蛋白（ＩＧＦＢＰｓ）和ＩＧＦＢＰ 蛋白酶已被证实,但对它们的功能尚不了解。本文使用上泳法优选精子,并应用计算机辅助精子分析技术（ＣＡＳＡ）研究ＩＧＦｓ 和ＩＧＦＢＰｓ 对体外精子活动参数的影响,如：曲线速度（ＣＶ）、直线速度（ＰＶ）、直线性（Ｌｎ）、前向性（Ｓｔ）、精子头侧摆幅度（ＡＬＨ）和鞭毛摆动频率（ＢＦ）。用方差分析评价各试验组与对照组间随培育时间精子活动参数的变化。结果显示ＩＧＦⅠ使ＣＶ 和ＡＬＨ 显著减少（Ｐ＜ ０．０５）;而ＩＧＦ Ⅱ试验组精子活动参数没有变化。完整的ＩＧＦＢＰ ３使Ｌｎ、Ｓｔ、ＢＦ显著增加（Ｐ＜ ０．０５）,使ＡＬＨ 显著减少（Ｐ＜ ０．０５）;但ＩＧＦＢＰ ２对精子活动参数却没有显著的影响。当ＩＧＦ Ⅰ和ＩＧＦＢＰ ３同时被加到精子样品中培育时,未发现对精子活动参数有统计意义的改变。我们的结论是ＩＧＦ Ⅰ和完整的ＩＧＦＢＰ ３对体外精子活动参数有着不同、而且是相反的影响,这可能在生育调节方面有一定的功用。     

卵巢肿瘤患者血清CA19—9水平升高的临床意义

目的探讨血清CA19-9水平在卵巢肿瘤中的升高情况及临床意义。方法回顾性分析首都医科大学附属北京友谊医院2007年1月至2008年12月间收治的377例卵巢肿瘤患者的血清CA19-9水平及相关的临床资料。结果377例患者中,血清CA19-9水平升高者89例,阳性率23．6％0。主要见于成熟畸胎瘤、卵巢子宫内膜异位囊肿、交界性肿瘤及恶性肿瘤患者,其阳性率分别为27．3％、31．7％、42．9％和28．1％,高于良性肿瘤（19．3％）、卵巢瘤样病变（23．9％）和卵巢转移癌（12．5％）,但差异无统计学意义（P〉O．05）;双侧卵巢成熟畸胎瘤的阳性率为53．3％,高于单侧（19．6％）,差异无统计学意义（P〉O．05）。CA19-9检测卵巢恶性肿瘤的特异度为76．6％,灵敏度为25％,与CAl25联合其灵敏度和特异度分别为82．5％和59．1％。结论CA19-9对卵巢畸胎瘤和子宫内膜异位囊肿的诊断有一定的参考价值,与CA125联用可提高卵巢恶性肿瘤的检出率。     

卵巢癌单抗183B2相应抗原的纯化及其特性分析

目的　纯化卵巢癌单克隆抗体 1 83B2相应抗原 ,并鉴定该抗原的理化特性。方法　将STRE AMLINErProteinA纯化的单抗 1 83B2与CNBr活化的sepharose 4B相偶联 ,制备亲和层析柱 ,再将用饱和硫酸铵粗提的病人腹水上柱纯化得到 1 83B2相应抗原。提纯抗原经高碘酸钠、胰蛋白酶、链酶蛋白酶、神经氨酸酶、去糖脂混合液及加热处理后进行间接ELISA检测。结果　经亲和层析纯化得到活性好的 1 83B2相应抗原。经高碘酸钠、神经氨酸酶、去糖脂混合液处理后抗原活性不变 ,而胰蛋白酶、链酶蛋白酶、及加热处理后抗原活性消失。结论　单抗 1 83B2相应的抗原决定簇位于肽链上 ,它可能是一种新的卵巢癌肿瘤相关抗原     

Prolonged symptom-free survival in a patient with persistent primary peritoneal carcinoma and a rising CA-125: a note of caution

BACKGROUND: The optimal management of patients with ovarian and primary peritoneal carcinomas who experience an elevation of the serum CA-125 antigen level following the completion of therapy, and who remain without other clinical evidence of recurrent/progressive disease, remains controversial. CASE: A patient with primary peritoneal carcinoma cared for in the Gynecologic Cancer Program of the Cleveland Clinic Foundation has experienced prolonged symptom-free survival (>4 years) after a documented tripling of her persistently elevated postchemotherapy serum CA-125 without the reinstitution of cytotoxic therapy. CONCLUSION: This case emphasizes that caution must be exercised when electing to initiate second-line treatment solely on the basis of an abnormal tumor antigen level.     

5T4 oncofetal antigen expression in ovarian carcinoma

5T4 oncofetal antigen is defined by a monoclonal antibody raised against human placental trophoblast, and recognizes a 72 kD glycoprotein expressed in many different carcinomas but detected only at low levels in some normal epithelia. Analysis of the patterns of expression of 5T4 oncofetal antigen in colorectal carcinomas has indicated a significant association between the presence of the antigen in tumor cells and metastatic spread. The 5T4 antigen expression of 72 epithelial ovarian carcinomas has been investigated by immunohistochemistry; 71% of the carcinomas demonstrated positive 5T4 immunoreactivity in adenocarcinoma cells and/or associated stromal tissue. In order to assess any relationship to prognosis, the 5T4 phenotypes were analyzed with respect to various clinicopathologic features of the tumors and the clinical outcome of the patients assessed by survival and disease-free interval. There was a significant correlation between 5T4 expression and more advanced stage of disease (FIGO stages III and IV) ( P < 0.001) and with poorly differentiated tumors ( P = 0.036) compared to well or moderately differentiated tumors. Patients with tumors expressing 5T4 were less likely to respond well to adjuvant therapy ( P = 0.030) and had a significantly worse outlook in terms of survival ( P = 0.033) and disease-free interval ( P = 0.033). This significance was not demonstrated as acting independently of FIGO stage and tumor differentiation.     

Serum MAGE-4 protein in ovarian cancer patients

OBJECTIVE: We measured serum levels of MAGE-4 protein in patients with ovarian cancer to investigate the relationship between serum MAGE-4 positivity and prognosis. METHODS: Serum levels of MAGE-4 protein were measured with an ELISA system. RESULTS: Serum levels of MAGE-4 in patients with ovarian cancer were significantly higher than levels in patients with benign diseases. Serum MAGE-4 protein was considered positive in 22% of primary ovarian cancer patients. The positive rate was the highest in sera of patients with surface epithelial-stromal tumors, particularly serous adenocarcinomas (24%). The survival time after a primary surgical operation in ovarian cancer patients with serum MAGE-4 positivity was significantly shorter than that of MAGE-4-negative cases. CONCLUSION: These results suggest that serum MAGE-4 protein is a potential prognostic factor of reduced survival in ovarian cancer patients.