血清CA125和HE4在子宫内膜癌中的表达及临床意义

目的检测血清糖类抗原125(carbohydrate antigen 125,CA125)和人附睾分泌蛋白4(human epididymis protein 4,HE4)在子宫内膜癌(EC)患者中的表达并研究其临床意义。方法选取2010年1月至2017年12月武汉市红十字会医院诊治的120例EC患者作为研究对象。将这120患者设为观察组,再选取50例子宫良性疾病患者设为对照组。比较两组患者血清CA125与HE4水平的差异,用统计学分析观察组不同临床病理特征患者的血清CA125与HE4水平的差异,并通过绘制患者工作特征(ROC)曲线以分析血清CA125、HE4单独或联合检测对EC的诊断价值,同时采用Pearson相关性分析EC患者血清CA125与HE4水平的关系。结果两组患者血清CA125水平的比较差异无统计学意义(P>0.05),而观察组患者血清HE4的水平较对照组患者显著升高,差异具有统计学意义(P<0.01)。在观察组患者中,病理分期为Ⅲ期~Ⅳ期、伴淋巴结转移、肌层浸润深度≥1/2肌层、腹腔积液或腹腔冲洗液中出现肿瘤细胞者中血清CA125与HE4的水平显著高于病理分期为Ⅰ期~Ⅱ期、无淋巴结转移、肌层浸润深度<1/2肌层或无浸润、腹腔积液或腹腔冲洗液中未出现肿瘤细胞的患者,差异具有统计学意义(P<0.01);年龄≥60岁、绝经、肿瘤分化程度为G3、肿瘤细胞出现脉管浸润患者中血清HE4的水平显著高于年龄<60岁、未绝经、肿瘤分化程度为G1~G2、肿瘤细胞未出现脉管浸润的患者,差异具有统计学意义(P<0.01)。血清CA125、HE4单独检测与联合检测诊断EC的ROC曲线下面积分别为0.61、0.86、0.90,其中血清HE单独检测或与CA125联合检测诊断EC的敏感度和准确性较CA125单独检测的诊断效能明显升高,且血清CA125联合HE检测的诊断效能更高,差异具有统计学意义(P<0.05)。经Pearson相关性分析结果显示,观察组患者血清CA125与HE4水平存在正相关关系,差异具有统计学意义(r=0.56,P<0.01)。结论血清HE4在EC患者中的水平明显升高,可能与患者病情进展及预后状况密切相关,并且血清HE4单独检测对EC的诊断价值较CA125检测明显升高,且二者联合检测在鉴别EC中具有更高的诊断价值。

Expression of serum human epididymis protein 4 and carbohydrate antigen 125 in patients with endometrial cancer and its clinical significance

Objective To analyze the expression of serum carbohydrate antigen 125(CA125) and human epididymis protein 4(HE4) in patients with endometrial cancer(EC) and its clinical significance. Methods 120 patients with EC in Wuhan Red Cross Hospital from January 2010 to December 2017 were selected as observation group and 50 patients with benign uterine diseases were treated as control group. The difference in serum CA125 and HE4 levels between the two groups was compared. The difference in serum CA125 and HE4 levels in patients with different clinicopathological characteristics was analyzed by statistics. The diagnostic value of serum CA125 and HE4 in EC patients was analyzed by drawing receiver operating characteristic(ROC) curves. Pearson correlation was used to analyze the relationship between serum CA125 and HE4 levels in patients with EC. Results There was no significant difference in serum CA125 level between the two groups(P>0.05), but serum HE4 level in the observation group was significantly higher than that in the control group(P<0.01). In the observation group, serum CA125 and HE4 levels were significantly higher in patients with stage Ⅲ-Ⅳ, lymph node metastasis, myometrial infiltration≥ 1/2 of myometrium, peritoneal effusion or peritoneal lavage fluid than those in patients with stage Ⅰ-Ⅱ, no lymph node metastasis, myometrial infiltration < 1/2 of myometrium or no infiltration, no tumor cells in peritoneal effusion or peritoneal lavage fluid. The level of serum HE4 in patients with age ≥ 60 years old, menopause, G3 of tumor differentiation and vascular invasion of tumor cells was significantly higher than that in patients with age < 60 years old, menopause, G1-G2 of tumor differentiation and no vascular invasion of tumor cells(P<0.01). The area under ROC curve of serum CA125 and HE4 were 0.61, 0.86 and 0.90, respectively. The sensitivity and accuracy of serum HE detection alone or combined with CA125 in diagnosing EC were significantly higher than that of CA125 alone, and the diagnostic efficiency of serum CA125 combined with HE detection was higher(P<0.01). Pearson correlation analysis showed that there was a positive correlation between serum CA125 and HE4 levels in the observation group(r=0.56, P<0.01). Conclusions The levels of serum HE4 in patients with EC are significantly increased, which may be closely related to the progression and prognosis of patients with EC. The diagnostic value of serum HE4 detection alone is significantly higher than that of CA125 detection, and the combined detection of serum HE4 and HE4 has higher diagnostic value in differentiating EC.