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。     

NLR检测在子宫内膜异位疾病和子宫肌瘤的应用价值及意义

目的:探讨血中性粒细胞/淋巴细胞比值(NLR)检测在子宫内膜异位疾病和子宫肌瘤的应用价值及意义.方法:研究对象为在我院手术并经术后病理检查证实的子宫腺肌病102例(子宫腺肌病组)、子宫内膜异位症47例(子宫内膜异位症组)和子宫平滑肌瘤80例(子宫肌瘤组),以及在此期间健康体检的正常妇女72例(对照组).检测所有患者术前及对照组患者体检时的血NLR、白细胞数、淋巴细胞数、CA125、CA199值,并比较分析,评价NLR、CA125及CA199在3种疾病的诊断敏感性.结果:3种疾病组血NLR值均明显高于对照组(P＜0.05或P＜0.01).3种疾病组血NLR比较差异无统计学意义(P＞0.05).子宫内膜异位症组Ⅲ、Ⅳ期患者的血CA125值及阳性率明显高于Ⅰ、Ⅱ期患者,两者差异均有高度统计学意义(P＜0.01),但各期间血NLR及CA199值及阳性率差异无统计学意义(P＞0.05).结论:NLR在子宫腺肌病、子宫内膜异位症和子宫肌瘤都显著升高,表明免疫抑制是这3种疾病的共性.血NLR、CA125及CA1993种血清指标联合检测对这3种疾病的鉴别诊断有一定的价值.     

子宫腺肌病与子宫肌瘤的临床比较

目的 探讨子宫腺肌病与子宫肌瘤的临床特点及B超、实验室检测的价值，提高对子宫腺肌病术前的诊断率。方法 选择5年来我院妇产科子宫切除术后经病理证实的子宫腺肌病患者120例为子宫腺肌病组，随机选择同期子宫切除术后经病理证实的子宫肌瘤患者120例为子宫肌瘤组，对两组患者年龄分布、既往史、临床症状、术前诊断、B超检查、血清CA125水平进行比较。结果 两种疾病均好发于生育年龄妇女，常有月经过多或经期延长，经分析差异无显著性（P〉0．05）。子宫腺肌病术前诊断率56．1％，出现痛经、性交痛较多，但继发性贫血少；具有特征性的超声表现；血清CA125水平明显升高。结论 子宫腺肌病诊断的金标准是病理诊断，但其既往史、特有症状、B超改变、血清CA125水平增高仍是诊断该病的重要参考指标，并可与子宫肌瘤进行手术前鉴别。     

子宫内膜细胞增生相关核抗原ki67和CA125在子宫腺肌病组织中的表达

目的 :①通过观察子宫内膜细胞增生相关核抗原ki6 7的表达探讨子宫内膜增殖能力对子宫腺肌病发病的影响。②研究子宫腺肌病患者血清CA12 5升高的来源和意义。方法 :手术切除子宫标本共 5 9例 ,其中子宫腺肌病 (简称 :腺肌病 ) 2 7例 ,子宫肌瘤 (简称 :肌瘤 ) 32例。应用免疫组化方法检测CA12 5、ki6 7在子宫腺肌病和子宫肌瘤患者子宫内膜、腺肌病病灶中的表达。免疫化学发光法测定血清CA12 5水平。结果 :两组在位内膜腺体ki6 7表达强度增生期较分泌期显著增强 ,P <0 .0 5 ,腺肌病组异位内膜ki6 7表达无周期性变化 ,腺肌病组异位内膜腺体ki6 7的表达在分泌期强于其自身在位内膜 ,P <0 .0 5 ,腺肌病组子宫内膜与肌瘤组子宫内膜ki6 7表达无统计学差异。腺肌病组血清CA12 5水平显著高于肌瘤组 ,P <0 .0 0 1,两组血清CA12 5水平增生期与分泌期差异均无显著性。腺肌病组与肌瘤组内膜间及腺肌病组在位内膜与异位内膜腺上皮间CA12 5表达差异无显著性 ,并且均无周期性变化。结论 :①腺肌病异位内膜ki6 7表达增多 ,增生能力较在位内膜增强 ,说明子宫内膜侵入子宫肌层后 ,增殖能力明显增强在疾病的发展中可能有一定作用。②血清CA12 5水平腺肌病组明显高于肌瘤组。     

盆腔良性肿物伴血清CA125水平升高的临床意义

目的探讨血清CA125水平在妇科良性肿瘤、结核性肿物及其他炎症性肿物、子宫内膜异位症等盆腔良性肿物中的升高情况及临床意义.方法回顾性分析中国医学科学院中国协和医科大学肿瘤医院于1999年1月-2003年12月间收治并经病理检查证实的492例妇科盆腔良性肿物患者的临床资料,其中卵巢良性肿瘤237例,其他盆腔良性肿物如子宫肌瘤、子宫腺肌病、卵巢子宫内膜异位症、盆腔结核及其他炎症性肿物等共255例,所有患者术前均有血清CA125的检测.另随机选取60例卵巢上皮性癌患者作为对照.结果盆腔结核、子宫腺肌病、卵巢子宫内膜异位症及卵泡膜-纤维组肿瘤患者的血清CA125水平中位数值均高于正常值(35 kU/L以下),分别是465.0、88.9、59.0、44.5 kU/L.本组盆腔良性肿物中, 血清CA125水平单例最高值为卵泡膜-纤维组肿瘤(1281.0 kU/L),中位数值最高者为盆腔结核(465.0 kU/L).60例卵巢上皮性癌患者血清CA125水平升高者达95.0%,其中位数值是755.5 kU/L,与良性肿物相比,差异有统计学意义(P<0.01 ).在子宫肌瘤与子宫腺肌病的鉴别诊断中,以血清CA125≥50 kU/L为标准,诊断子宫腺肌病的敏感性、特异性、阳性预测值及阴性预测值相对较高,分别是72%、94%、79%和91%.结论血清CA125水平升高也可见于一些盆腔良性肿物,主要有盆腔结核、子宫腺肌病、卵巢子宫内膜异位症及卵泡膜-纤维组肿瘤等,但其中位数值均明显低于卵巢上皮性癌.血清CA125水平检测有利于子宫肌瘤和子宫腺肌病的鉴别诊断.     

人附睾蛋白4对子宫内膜癌的风险评估研究

目的：探讨血清人附睾蛋白4（HE4）、癌抗原125（CA125）对子宫宫体疾病患者患子宫内膜癌风险的评估价值。方法：采用电化学发光法检测453例子宫肌瘤患者、126例子宫腺肌病患者、26例子宫内膜增生患者、10例子宫内膜息肉患者、212例子宫内膜癌患者以及72例体检正常妇女血清HE4和CA125水平。结果：血清HE4在子宫内膜癌组的表达水平高于其他各组,差异有统计学意义（均P＜0.01）;血清CA125在子宫腺肌病组的表达水平高于其他各组,差异有统计学意义（均P=0.000）;子宫内膜癌患者血清HE4表达水平与国际妇产科联盟（FIGO）分期呈正相关（rs=0.538,P=0.000）;HE4与CA125联合检测子宫内膜癌的敏感度比单独HE4检测的敏感度高。结论：单独血清HE4以及与CA125联合检测对子宫内膜癌早期诊断、分期及预后评估都有一定意义,可以作为诊断子宫内膜癌的重要指标。     

动态监测CA125 EMAb对子宫动脉栓塞术治疗子宫腺肌病的疗效评价

目的采用血清CA125、子宫内膜抗体(EMAb)动态监测,评价子宫动脉栓塞术(UAE)治疗子宫腺肌病的疗效.方法 2002年3月至2004年3月对就诊于广州市妇婴医院、中山大学附属第三医院的86例确诊为子宫腺肌病患者,在UAE术前及术后连续动态监测血清CA125、EMAb之变化.结果血清CA125水平在UAE后第4周开始下降至(89±11.3)kU/L,和术前(128±44.3)kU/L比较,差异有显著性意义(P<0.05);术后CA125稳定下降,至18个月降至正常水平(<35kU/L);血清EMAb术前52例阳性,第2个月开始下降,和术前比较术后EMAb阳性率差异有显著性意义(P<0.05).结论血清CA125、EMAb动态监测UAE治疗子宫腺肌病的疗效,其方法简单且具有临床实用意义.     

超声检查及血清CA125测定诊断子宫腺肌病的评价

目的探讨超声检查及血清癌抗原125(CA125)测定对子宫腺肌病的诊断价值.方法通过对120例疑为子宫腺肌病或子宫肌瘤患者,行术前腹部B超和血清CA125测定;术后切下组织送病理学检查确诊并与之对照.结果经术后病理学证实子宫腺肌病组术前血清CA125检测敏感度73.8%, 特异度73.5%; B超诊断该病的敏感度55.4%, 特异度64.8%; 以两种方法联合检测均阳性为诊断标准, 则敏感度52.5%, 特异度94.1%.结论测定血清CA125水平,对子宫腺肌病是较好的辅助诊断指标;B超检查对该病有一定诊断价值;两者联合检测能提高诊断的正确性,且方法简便、快捷、无创伤,是目前较为实用的诊断方法.     

卵巢、子宫肌层组织及静脉血中氧自由基代谢与子宫内膜异位症、子宫腺肌病发病的关系

目的探讨氧自由基与子宫内膜异位症(内异症)、子宫腺肌病(腺肌病)发病的关系.方法(1)测定32例卵巢内异症手术患者(内异症组)的静脉血,卵巢囊肿组织及囊液中脂质过氧化物(LPO)、微量元素硒(Se)、超氧化物歧化酶(SOD)、维生素E(VE)的水平;(2)测定23例腺肌病手术患者(腺肌病组)的静脉血、子宫肌层组织的LPO、Se、SOD、VE的水平.另外选取30例单纯子宫肌瘤患者作为对照(对照组).结果(1)内异症组静脉血、卵巢组织中LPO水平为(6.357±1.251)μmol/L、(3.735±1.546)nmol/g蛋白,高于对照组的(3.547±1.640)μmol/L、(1.105±0.653)nmol/g蛋白(P＜0.01);Se、SOD、VE水平均低于对照组(P＜0.01～0.05).(2)内异症组卵巢囊液中LPO水平高于自身静脉血及对照组静脉血(P＜0.01);(3)腺肌病组静脉血及子宫层肌组织LPO水平为(5.882±1.711)μmol/L及LPO水平(2.937±1.577)nmol/g蛋白,高于对照组的(3.547±1.640)μmol/L及(1.754±0.833)nmol/g蛋白(P＜0.01);静脉血Se、VE、SOD水平均低于对照组(P＜0.01);子宫肌层组织中Se、VE水平低于对照组(P＜0.01),而子宫肌层组织中SOD水平与对照组比较,差异无显著性(P＞0.05).结论内异症及腺肌病的发病与氧自由基的代谢失衡有关;与LPO增多有关.     

子宫腺肌病与子宫肌瘤310例的临床相关及对比分析

目的 对310例子宫腺肌病与子宫肌瘤患者进行临床相关及对比分析，以利于指导临床治疗与诊断。方法回顾性分析了310例子宫腺肌病与子宫肌瘤的临床资料。结果 两者大多数见于30—50岁生育年龄的妇女（P〉0．05）。而与子宫肌瘤相区别的是，子宫腺肌病的临床表现为痛经、盆腔深部痛或性交痛，盆腔检查子宫增大多〈2个半月，活动度差，后穹隆有触痛，血清CA125增高，术前误诊率高。两者相比，差异有显著性（P〈0．05）。结论 二者共同的发病因素可能是高雌激素刺激。术前诊断子宫腺肌病应在结合病史、临床症状及盆腔检查的同时，结合B超、血清CA125测定等检查，进行综合判断。     

CA125 in peritoneal fluid of ovarian cancer patients.

The presence of CA125 was assessed in peritoneal fluid from 70 patients with ovarian cancer and 32 control patients. The follow-up period ranged from 39 to 89 months (median, 56 months). The cutoff for normal peritoneal fluid CA125 levels was determined to be 250 U/ml. A positive correlation between the serum and peritoneal fluid CA125 levels was observed (P less than 0.001). Peritoneal fluid levels were higher than serum levels in all patients. Patients with evidence of active ovarian cancer showed higher peritoneal fluid CA125 levels than the control patients (P less than 0.001). Peritoneal fluid CA125 levels correlated inversely with survival (P = 0.004). The peritoneal fluid CA125 levels were higher in patients with bulky tumor than in those with small (less than 1 cm) tumors (P less than 0.001). Eight out of twenty-six patients with active cancer and available peritoneal cytology had a negative peritoneal cytology. Three of these patients showed elevated peritoneal fluid levels. Three patients out of twenty-four showed elevated peritoneal fluid CA125 levels at second-look laparotomy. These 3 patients had negative biopsies at second-look surgery, but relapsed during the observation period. At second-look laparotomy an elevated peritoneal fluid CA125 level may imply a bad prognosis, but a normal level does not exclude the presence of disease.     

CA 125 in peritoneal fluid: reliable values at high dilutions.

Forty-three samples of peritoneal fluid from women undergoing laparotomy or laparoscopy for various gynecologic diseases were examined to determine and characterize CA 125 antigen. The data were compared with the corresponding serum levels. CA 125 levels in undiluted peritoneal fluid ranged between 41-301 U/mL and were significantly higher than levels in serum, except in cases of ovarian carcinoma. However, when CA 125 of peritoneal fluid was measured at dilutions greater than 1:50, higher antigen levels were measured (1120-31,500 U/mL), with the highest CA 125 values in patients with ovarian carcinoma. Measurements at dilutions of less than 1:50 were also affected but did not show any decreased binding of the antigen. Immunoblotting analysis of serum and peritoneal fluid indicated the presence of two main bands in each. The monoclonal antibody OC 125 reacted strongly with peritoneal fluid CA 125, in agreement with the CA 125 values obtained by immunoradiometric assay using high dilutions. These data suggest that CA 125 measurements in peritoneal fluid are unreliable unless the samples are diluted 1:50 or more. Furthermore, the statistical difference found between patients with benign and malignant tumors and those with leiomyomata uteri and controls suggests that diluted peritoneal fluid could have a role in identifying abnormal antigen levels.     

Fundamental and clinical study on source of CA 125 antigen in cul-de-sac fluid and translation into systemic circulation

CA125 levels in cul-de-sac fluid were measured in patients with endometriosis and patients with myoma uteri in order to investigate the participation of CA125 of endometrial tissue origin in peritoneal fluid levels. The translation of peritoneal fluid CA125 into the systemic circulation was also examined in an experiment on rabbits. 1. The CA125 concentrations in peritoneal fluid in patients with endometriosis and those with myoma uteri were similar. 2. High concentrations of CA125 in peritoneal fluid were also observed in patients who had undergone hysterectomy with bilateral salpingo-oophorectomy. 3. There is little correlation between the extracted tissue weight and CA125 concentrations in cul-de-sac fluid in patients with adenomyosis. 4. In patients with endometriosis, although CA125 concentrations in peritoneal fluid decreased transiently during conservative hormonal treatment, an increase in CA125 concentrations in peritoneal fluid was observed again after treatment. 5. CA125 concentrations in serum and in peritoneal fluid in ovarian cancer patients with peritonitis carcinomatosa were significantly higher than those without peritonitis carcinomatosa. 6. The experiment on rabbits indicates that the translation rate of CA125 antigen and the degree of chemical peritonitis treated with CH3COOH are in inverse proportion. Consequently, CA125 antigen in peritoneal fluid seems to be derived from others such sources as the peritoneum in addition to endometrial tissues.     

Differential diagnosis between leiomyomata uteri and adenomyosis using CA 125 as a new tumor marker of ovarian carcinoma

To differentiate pre-operatively between leiomyomata uteri and adenomyosis, we measured serum levels of an antigen (CA 125) common to most nonmucinous epithelial ovarian carcinoma in patients with benign uterine tumor (11 of leiomyomata uteri, 7 of adenomyosis and 1 of adenomyosis with leiomyomata uteri). CA 125 in serum samples pre and postoperatively were measured using an RIA Kit. The normal range of CA 125 levels was below 35U/ml. The mean CA 125 level (+/- S.D.) was 18.3 +/- 6.1U/ml in patients with leiomyomata uteri and 93.3 +/- 49.4U/ml in those with adenomyosis. Student's t-test showed a significant correlation (0.001 less than p less than 0.01). The mean CA 125 level in patients with adenomyosis was statistically higher than that in disease-free women. Among 7 patients with surgically demonstrable adenomyosis, the CA 125 values were over 35U/ml (87.5%). In all 11 patients with surgically demonstrable leiomyomata uteri, the CA 125 level was below 35U/ml. The CA 125 level in patients with adenomyosis gradually decreased postoperatively and in all was below 35U/ml up to one month postoperatively. Using this approach, leiomyomata uteri and adenomyosis can be differentiated, pre-operatively.     

左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病2年临床观察

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)治疗子宫腺肌病(adenomyosis,AM)的临床疗效及不良反应。方法:观察58例子宫腺肌病患者LNG-IUS放置前、放置后1个月、3个月、6个月、12个月、18个月、2年的痛经视觉模拟评分法(VAS)评分、月经量、血清CA125、子宫体积和内膜厚度及相关不良反应。结果:LNG-IUS放置后患者痛经明显缓解,VAS评分明显下降,月经量明显减少,子宫内膜变薄,并持续保持疗效,与放置前相比较,差异均有统计学意义(P<0.01);在一定程度上,子宫体积缩小,CA125降低,但差异均无统计学意义(P>0.05)。不良反应主要为阴道少许点滴出血,充分解释后患者多能接受;另有少量脱环、功能性卵巢囊肿、闭经、痤疮等。结论:LNG-IUS是治疗子宫腺肌病的一种有效的保守治疗方法,适合用于痛经和/或月经过多的子宫腺肌病患者。     

联合测定子宫内膜异位症患者血清中EMAb及CA125的临床评价

目的：对联合测定子宫内膜异位症（内异症）患者血清中ＥＭＡｂ及ＣＡ１２５进行临床评价。方法：采取内异症１０９例术前（内异症组）和健康妇女３０例（对照组）空腹静脉血，用酶联免疫吸附法（ＥＬＩＳＡ）测定两组血清中ＥＭＡｂ水平；用放射免疫法（ＲＩＡ）测定血清中ＣＡ１２５水平。结果：内异症组ＥＭＡｂ阳性率为６３．３０％，对照组为１０％，两组差异有显著性（Ｐ＜０．０５）。内异症各期及子宫腺肌病间ＥＭＡｂ阳性率差异无显著性（Ｐ＞０．０５）。内异症组血清ＣＡ１２５水平平均为７０．７０±１６．６２Ｕ／ｍｌ，对照组为１５．３８±５．３２Ｕ／ｍｌ，两组差异有显著性。如以ＣＡ１２５≥３５Ｕ／ｍｌ为阳性界值，则内异症组阳性率为８０．２３％，对照组为６．６６％。单独测定ＥＭＡｂ诊断内异症的敏感性为６３．３０％，特异性为９０％；单独测定ＣＡ１２５诊断内异症的敏感性为８０．２３％、特异性为９３．３３％。如以两者均阳性为诊断标准，则敏感性为５７．８０％，特异性为１００％；如以其中之一阳性为诊断标准，则敏感性为９１．７４％，特异性为８３．３３％。结论：测定内异症患者血清中ＥＭＡｂ及ＣＡ１２５水平对内异症有较好的辅助诊断价值，联合测定ＥＭＡｂ及?     

Usefulness of measurement of serum CA125 levels in diagnosing and treating endometriosis

We investigated the usefulness of the measurement of serum CA125 levels for the diagnosis and therapeutic monitoring of endometriosis. An additional study concentrated on the production of CA125. 1. Elevated levels of serum CA125 were noted in 52 of 66 patients with endometriosis in which the positive rate was 78.8% and mean was 119.8 U/ml. The mean value and positive rate of serum CA125 levels in patients with adenomyosis were higher than those in pelvic endometriosis. 2. The correlation between preoperative serum CA125 levels and the extracted tissue weight was statistically significant. The tissue concentration of CA125 of adenomyosis was 1,479.3 +/- 1,087.1 U/g and that of pelvic endometriosis was 309.7 +/- 23.1 U/g wet weight. 3. The serum CA125 levels in patients with adenomyosis fell postoperatively, and all were below 35 U/ml within two weeks. The serum CA125 levels were below 35 U/ml in 13 out of 15 patients (86.7%) with pelvic endometriosis treated with danazol and the change in the serum CA125 levels was closely related to the clinical course. 4. Clinicopathological states with a high level of serum CA125 were observed in patients with normal and ectopic pregnancy, puerperium, ovarian hyperstimulation syndrome (OHSS) and peritonitis. It was concluded that the measurement of serum CA125 levels was useful in the diagnosis and therapeutic monitoring of endometriosis, and CA125 might be produced and/or secreted not only from the endometrium but also from the peritoneum.     

释放左炔诺孕酮的宫内节育器治疗子宫腺肌病

目的　探讨释放左炔诺孕酮的宫内节育器治疗子宫腺肌病的疗效和安全性。方法　观察32例子宫腺肌病患者放置释放左炔诺孕酮的宫内节育器前后痛经症状、月经情况、子宫体积、血清CA12 5和不良反应。结果　患者放置释放左炔诺孕酮的宫内节育器1个月后痛经程度明显减轻,痛经程度评分由放置前的2 7分降为放置1个月后的0 7分(P <0 0 1) ,放置3个月后所有患者的痛经症状消失。子宫体积于放置6个月后稍缩小,但不明显(P >0 0 5 ) ,以后变化也不明显。血清CA12 5于放置3个月后明显降低(P <0 0 1) ,且降至正常范围,以后维持在较低的水平。结论　释放左炔诺孕酮的宫内节育器治疗子宫腺肌病安全有效,为一种较好的保守治疗手段。