血清CA125,STIP1和IGF-Ⅰ联合检测对卵巢癌的早期诊断价值研究

目的 探讨血清糖类抗原125(carbohydrate antigen 125,CA125),磷酸化应激诱导蛋白1(stress-induced phosphoprotein 1,STIP1)和胰岛素样生长因子-Ⅰ(insulinlike growth factor-Ⅰ,IGF-Ⅰ)联合检测对卵巢癌的早期诊断价值。方法 枣庄矿业集团中心医院于2015年11月～2017年11月期间收治的经手术病理证实的90例卵巢癌患者作为卵巢癌组,同期该院收治的40例良性卵巢肿瘤患者作为卵巢良性肿瘤组,同期来该院体检的40例健康妇女作为健康组,检测血清CA125,STIP1和IGF-Ⅰ水平,对比三者单独及联合诊断卵巢癌的效果。结果 卵巢癌组、卵巢良性肿瘤组、健康组血清CA125水平分别为680.2±96.5,20.4±2.9和11.4±1.9 U/ml,血清STIP1水平为5.06±1.07,2.02±1.05和1.03±0.92 ng/ml,血清IGF-Ⅰ为120.4±32.4,215.4±34.3和190.3±45.6 ng/ml,经多个均数之间两两比较的q检验比较,卵巢癌组血清CA125,STIP1和IGF-Ⅰ水平与卵巢良性肿瘤组、健康组间差异具有统计学意义(q=14.319～70.632,均P<0.001); 血清CA125,STIP1和IGF-Ⅰ单独检测诊断卵巢癌的ROC曲线下面积分别为0.715,0.748和0.781,最佳诊断临界值为35 U/ml,3.2 ng/ml和174.5 ng/ml,三者单独检测诊断卵巢癌的敏感度为78.9%,86.7%和75.6%,特异度为72.5%,57.5%和63,8%,准确度为75.9%,72.9%和70.0%,卡方检验显示差异无统计学意义(χ²=2.345～3.971,均P>0.05); CA125+STIP1,CA125+STIP1+IGF-I平行联合诊断卵巢癌的ROC曲线下面积为0.812和0.854,诊断敏感度为90.0%和96.7%,特异度为60.0%和67.5%,准确度为75.9%和82.9%,卡方检验显示差异无统计学意义(χ²=0.974,3.073,P>0.05); CA125+STIP1,CA125+STIP1+IGF-I系列联合检测诊断卵巢癌的ROC曲线下面积为0.834和0.921,诊断特异度为81.3%和92.5%,准确度为75.9%和87.1%,组间比较差异具有统计学意义(χ²=4.440,7.033,P<0.05); CA125+STIP1+IGF-I系列联合检测诊断的特异度和准确度显著高于单独检测CA125,STIP1和IGF-Ⅰ(χ²=2.475～12.135,P<0.05)。结论血清CA125,STIP1和IGF-Ⅰ单独诊断卵巢癌敏感度和特异度较低,三者平行联合检测可提高诊断准确度,系列联合检测可提高特异度和准确度,有助于卵巢癌早期筛查和诊断。

Clinical Value of Combined Detection of Serum CA125,STIP1 and IGF-I Levels in Early Diagnosis of Ovarian Cancer

Objective To explore the diagnostic value of combined detection of serum carbohydrate antigen 125(CA125),stress-induced phosphoprotein 1(STIP1)and insulinlike growth factor-Ⅰ(IGF-I)in early diagnosis of ovarian cancer.Methods 90 patients with ovarian cancer confirmed by pathology admitted from November 2015 to November 2017 were treated as ovarian cancerobservation group,40 patients with benign ovarian tumors admitted in the same periods were as ovarian benign tumor group 1,40 healthywomen examined in the same periods were as healthy.To measure the serum CA125,STIP1 and IGF-I level,and compared the diagnosis efficacy of all indexes aloneand jointly to diagnose ovarian cancer.Results The serum CA125 levels in ovarian cancerobservation group,varian benign tumor control,and healthy were 680.2±96.5,20.4±2.9 and 11.4±1.9 U/ml,and the serumSTIP1 level was 5.06±1.07,2.02±1.05 and 1.03±0.92 ng/ml,serum IGF-Iwas 120.4±32.4,215.4±34.3 and 190.3±45.6 ng/ml,respectively.The q test of the comparison of multiple mean comparisons showed that there was a statistically significant difference between observation group and the ovarian benign tumor group and healthy group(q=14.319～70.632,P<0.001).The areasunder ROC curve of serum CA125,STIP1 and IGF-I alone in the diagnosis of ovarian cancer were 0.715,0.748 and 0.781 respectively.The best diagnostic thresholds were 35 U/ml,3.2 ng/ml and 174.5 ng/ml.The sensitivity of the cancer was 78.9%,86.7% and 75.6%,the specificity was 72.5%,57.5% and 63.8%,the accuracy was 75.9%,72.9% and 70.0%.The chi-square test showed no statistically significant difference(χ²=2.345～3.971,all P>0.05).Thearea under the ROC curve of CA125+STIP1,CA125+STIP1+IGF-I parallel diagnosisof ovarian cancer was 0.812 and 0.854,the diagnostic sensitivity was 90.0% and 96.7%,the specificity was 60.0% and 67.5%,the accuracy was 75.9% and 82.9%,Chi-square test showed no significant difference(χ²=0.974,3.073,P> 0.05).CA125+STIP1,CA125+STIP1+IGF-I series of ovarian cancer under the ROC curve of the area of 0.834 and 0.921,thediagnostic specificity of 81.3% and 92.5%.The accuracy was 75.9% and 87.1%.The difference between the twogroups was statistically significant(χ²=4.440,7.033,all P<0.05).The specificity and accuracy of the combined diagnosis of CA125+STIP1+IGF-Iwere significantly higher than those of the two groups.Diagnosis of CA125,STIP1 and IGF-I(χ²=2.475～12.135,all P<0.05).ConclusionSerum CA125,STIP1 and IGF-I alone in diagnosis ovarian cancer hadlow sensitivity and specificity,the parallel diagnosis could improve diagnostic accuracy,the series diagnosis could improve diagnostic specificity and accuracy.It could help early screening and diagnosis for ovarian cancer.