HE4和CA125联合检测在卵巢癌诊断及鉴别诊断中的价值

目的探讨卵巢肿瘤患者血清人附睾上皮分泌蛋白4（HE4）水平的改变及与临床病理特征,并探讨其与糖类抗原125（CA125）联合检测在卵巢癌诊断与鉴别诊断中的应用价值。方法选择2009年10月～2011年2月在广东省人民医院妇科病区住院卵巢疾病患者77例为研究对象,根据术后病理结果将其分为良性病变组56例,卵巢癌组21例。测定血清HE4与CA125水平,分析血清HE4在各组中水平的差异及其与CA125联合检测的灵敏度。结果卵巢癌组患者的血清HE4水平显著高于良性病变组（P〈0.05）;HE4水平随FIGO临床分期增高而增高,Ⅲ～Ⅳ期与Ⅰ～Ⅱ期患者相比,血清HE4水平差异有统计学意义（P〈0.05）,但有无淋巴结转移者之间差异无统计学意义（P〉0.05）;以卵巢良性疾病作参照,单独检测血清HE4水平,当血清HE4临界值为76.5 pmol/L,血清HE4检测ROC曲线下面积为0.878,对卵巢癌诊断的灵敏度为80.95%,特异度为85.71%;联合检测HE4和CA125对卵巢癌诊断的灵敏度为90.05%。结论 HE4是卵巢癌较好的肿瘤标志物,联合检测HE4与CA125有利于卵巢癌的诊断与鉴别诊断。

The value of the combined detection of human epididymis protein 4 and cancer antigen 125 in the diagnosis and differential diagnosis of ovarian carcinoma

Objective To study the changes of serum levels of human epididymis protein 4（HE4） and their clinicopathologic feature and explore the clinical value of the combined detection of human epididymis protein 4（HE4） and cancer antigen 125（CA125） in the diagnosis and differential diagnosis of ovarian carcinoma. Methods 77 patients from October 2009 to February 2011 in Gynaecology Department of Guangdong Provincial People＇s Hospital were selected as study objects,and they 56 with ovarian or adnexal benign diseases were selected as benign lesions group,21 with ovarian carcinoma were selected as ovarian carcinoma group according to the postoperative pathological results. The levels of HE4 and CA125 were detected,the changes of serum levels of HE4 in different groups and the sensitivity of combined detection with CA125 were analyzed. Results The serum levels of HE4 in ovarian carcinoma group were significantly higher than that of the gynecological benign lesions group（P 0.05）; with the FIGO clinical stage increased,the levels of HE4 increased,the serum levels of HE4 in phase Ⅰ and Ⅱ were statistically different with that in phase Ⅲ and Ⅳ（P〈 0.05）. The serum HE4 levels in patients with lymph node metastasis or not had no statistically significant difference（P〉 0.05）. Using the women of gynecological benign diseases as the reference,when the cutoff point of serum HE4 was set at 76.5 pmol/L and the area under the ROC curve in HE4 single detection were 0.878. The sensitivity was 80.95%,while the specificity is 85.71%; the sensitivity of combined detection with CA125 was higher than that of single test,which was as high as 90.05%. Conclusion HE4 is a useful biomarker for ovarian carcinoma. Combined detection of CA125 and HE4 can increase the detection rate and improve the diagnosis and differential diagnosis of ovarian carcinoma.