人附睾蛋白4与癌抗原125在卵巢癌二元论模型中的应用

目的：探讨血清人附睾蛋白4（HE4）、CA125对上皮性卵巢癌（EOC）二元论模型的应用价值。方法：选取2012年2月-2013年4月间因盆腔包块或卵巢囊肿住院拟行手术的患者，包括妇科炎症65例，子宫内膜异位症（EMs）509例，卵巢良性肿瘤887例，卵巢交界性上皮瘤73例，EOC 132例（Ⅰ型78例，Ⅱ型54例），以及正常妇女71例。采用电化学发光法检测其血清HE4、CA125水平，并评估其应用价值。结果：EOC患者血清HE4和CA125水平与国际妇产科联盟（FIGO）分期呈正相关（rs分别为0.534，0.541，均P=0.000）；各期Ⅱ型EOC HE4、CA125表达水平高于同期Ⅰ型EOC，高级浆液性癌高于低级浆液性癌，各期EOC HE4表达水平高于妇科良性疾患各组（P＜0.05）；Ⅰ期EOC患者血清CA125表达与妇科炎症、EMs组差异无统计学意义（均P＞0.05），Ⅱ、Ⅲ期Ⅰ型EOC患者血清CA125表达与EMs组差异无统计学意义（均P＞0.05）。 HE4、CA125检测EOC的受试者工作曲线下面积（ROC-AUC）分别为0.877，0.786；准确度为90.0%，70.5%；敏感度67.4%，69.7%；特异度92.1%，72.6%；约登指数0.595，0.403。结论：HE4单项检测EOC的特异度优于CA125，单独血清HE4及其与CA125联合检测对EOC早期诊断、分期、病理分型及预后评估都有一定意义，可以作为诊断EOC的重要指标。

Application of Tumor Markers for the Dualistic Model about Epithelial Ovarian Cancer

Objective：To explore serum human epididymis protein 4 （HE4）,cancer antigen 125 （CA125） for the dualistic model about epithelial ovarian cancer （EOC） application value. Methods：The electrochemical luminescence method to detect serum HE4 and CA125 levels of patients in hospital to be intend to do surgery because of pelvic masses or ovarian cyst from February 2012 to April 2013,including gynecological inflammation（n=65）,endometriosis （n=509）,benign ovarian tumors（n=887）,borderline ovarian tumors（n=73）,epithelial ovarian cancer（n=132,78 cases ofⅠtype,54 cases ofⅡtype） and 71 cases of healthy women,to evaluate in application value of the model. Results：Epithelial ovarian cancer patients serum HE4 and CA125 expression level and FIGO stage were a significant positive correlation （rs=0.534,0.541,P=0.000）. The serum level of HE4 and CA125 expression in the epithelial ovarian cancer of Ⅱtype were higher than that of the Ⅰ type in all stage,the difference was statistically significant. The serum level of HE4 expression in the high-grade serous carcinoma were higher than the low-grade serous carcinoma,the difference was statistically significant. The serum level of HE4 expression in epithelial ovarian cancer were higher than that of the other groups,the difference was statistically significant（P〈0.05）. The serum level of CA125 expression inⅠstage EOC and gynecological inflammation,endometriosis were no significant difference（P〉0.05）. The serum level of CA125 expression inⅡ-Ⅲstage EOC ofⅠtype and endometriosis were no significant difference （P〉0.05）. The area under the receiver operating curve （ROC-AUC） of HE4 and ROC were 0.877,0.786,accuracy （90.0%,70.5%）, sensitivity （67.4%,69.7%）,specificity （92.1%,72.6%）,Youden index （0.595,0.403）. Conclusions：The specificity of HE4 assay is higher than CAl25 assay in the diagnosis of ovarian carcinoma. Single serum HE4 and CA125 detection has a certain significance to the early diagnosis staging ,pathology typing and prognosis of epithelial ovarian cancer ,which can be used as an important index for the diagnosis of epithelial ovarian cancer.