血清YKL-40和CA125联合检测在卵巢癌诊断中的应用

目的探讨血清YKL-40和CA125联合检测在卵巢癌诊断中的应用价值。方法分别用酶免分析法（EIA）和微粒子酶免分析法（MEIA）测定39例卵巢癌、27例卵巢良性肿瘤及40例健康对照妇女血清YKL-40和CA125水平，YKL-40以健康对照组95％可信区间的上限值为阳性，比较YKL-40和CA125在三组间、卵巢癌病人不同临床分期和手术治疗前后水平和阳性率的差异。结果正常对照组血清YKL-40水平的95％可信区间的上限值为71．9ng／mL；卵巢癌患者血清YKL-40水平及阳性率显著高于卵巢良性肿瘤组和对照组（t〉4．83，P〈0．01），而卵巢良性肿瘤组和对照组之间差异无统计学意义（t=0．96，P〉0．05）。Ⅲ／Ⅳ期卵巢癌患者血清YKL-40水平显著高于Ⅰ／Ⅱ期患者（167．9ng／mL vs 87．7ng／mL，t=1．86，P〈0．01）。卵巢癌患者术后第3天和第7天血清YKL-40水平显著低于术前水平（t〉2．92，P〈0．01）；未能手术切除的患者血清YKL-40水平显著高于手术切除者（t=4．06，P〈0．01）。YKL-40联合CA125诊断卵巢癌的灵敏度为87．2％，特异性为91．0％，阳性预测值为85．0％，阴性预测值为92.4％；YKL-40与CA125联合诊断早期卵巢癌的灵敏度从CA125单指标的33．3％提高到66．7％。结论YKL-40是一种新的诊断卵巢癌的肿瘤标志物，联合YKL-40与CA125检测可提高对早期卵巢癌诊断的灵敏度。

Clinical Value of Combined Detection of Serum YKL-40 and CA125 in Epithelial Ovarian Cancer Patients

Objective To investigate the clinical value of combined detection of serum YKL-40 and CA125 in patients with epithelial ovarian cancer （EOC）. Methods 40 healthy subjects （27 patients with benign gynecologic processes and 39 preoperative patients diagnosed with EOC） enrolled in the Baoan people＇ hospital between 2004 year and 2006 year were studied. The levels of YKL-40 were assayed by enzyme immunoassay （EIA）. Micropartical enzyme immunoassay （MEIA） was used to detect serum CA125 expression. YKL-40 value beyond the upper-limit of 95% credibility interval （95%CI） based on the health controls and CA125 value beyond 35 U/mL was defined as the positive value. The levels and positive rates of YKL-40 and CA125 were compared among the three groups and between patients with stage Ⅰ/Ⅱ and Ⅲ/Ⅳ EOC and between the preoperative and postoperative patients. Results The mean level of serum YKL-40 was 35.4 ng/mL （range, 8.8 to 107.2 ng/mL） for the healthy subjects, 39.6 ng/ mL （range, 13.2 to 89.1 ng/mL） for the individuals with benign ovarian disease, and 149.4 ng/mL （range, 38.9 to 622.0 ng/mL） for the EOC patients. The concentration of serum YKL-40 in patients with EOC was significantly higher than the patients with benign ovarian disease or in healthy subjects （149.4 ng/mL vs 39.6 ng/mL or 35.4 ng/ mL, P〈0.01）. No significant difference was found in the serum YKL-40 levels between the patients with benign gynecologic processes and healthy controls （39.6 ng/mL vs 35.4 ng/mL, P〉0.05）. When a cutoff point of 71.9 ng/ mL （95%CI of the YKL-40 concentration in healthy subjects） was selected as the positive YKL-40 value, the positive rate of YKL-40 in patients with EOC was significantly higher than the patients with benign gynecologic processes or in healthy subjects （76.9% vs 3.7% or 2.5%, P〈0.01）. Compared with those patients with stage Ⅰ/Ⅱ EOC （87.7 ng/ mL, 55.6%）, a higher level of serum YKL-40 （167.9 ng/mL, 83.3%, P〈0.01） was found in patients with stage Ⅲ /Ⅳ EOC. The preoperative YKL-40 values for the EOC patients were significantly higher than the postoperative values （98.8 ng/mL vs 63.8 ng/mL, P〈0.01 ）, and a significant difference was observed between the optimal and suboptimal surgery patients （98.8 ng/mL vs 230.4 ng/mL, P〈0.01 ）. The diagnostic sensitivity, specificity and the positive/ negative expected value for EOC of a link application of YKL-40 and CA125 was 87.2% and 91.0% and 85.0% and 92.4%, respectively. In patients with stage Ⅰ / Ⅱ EOC, application of these two markers can increase the sensitivity by 33.3% when compared with CA125 alone. Conclusion YKL-40 is a novel marker for the detection of EOC. Both YKL-40 and CA125 may be used in the early diagnosis of EOC.