盆腔良性肿物伴血清CA125水平升高的临床意义

目的探讨血清CA125水平在妇科良性肿瘤、结核性肿物及其他炎症性肿物、子宫内膜异位症等盆腔良性肿物中的升高情况及临床意义.方法回顾性分析中国医学科学院中国协和医科大学肿瘤医院于1999年1月-2003年12月间收治并经病理检查证实的492例妇科盆腔良性肿物患者的临床资料,其中卵巢良性肿瘤237例,其他盆腔良性肿物如子宫肌瘤、子宫腺肌病、卵巢子宫内膜异位症、盆腔结核及其他炎症性肿物等共255例,所有患者术前均有血清CA125的检测.另随机选取60例卵巢上皮性癌患者作为对照.结果盆腔结核、子宫腺肌病、卵巢子宫内膜异位症及卵泡膜-纤维组肿瘤患者的血清CA125水平中位数值均高于正常值(35 kU/L以下),分别是465.0、88.9、59.0、44.5 kU/L.本组盆腔良性肿物中, 血清CA125水平单例最高值为卵泡膜-纤维组肿瘤(1281.0 kU/L),中位数值最高者为盆腔结核(465.0 kU/L).60例卵巢上皮性癌患者血清CA125水平升高者达95.0%,其中位数值是755.5 kU/L,与良性肿物相比,差异有统计学意义(P<0.01 ).在子宫肌瘤与子宫腺肌病的鉴别诊断中,以血清CA125≥50 kU/L为标准,诊断子宫腺肌病的敏感性、特异性、阳性预测值及阴性预测值相对较高,分别是72%、94%、79%和91%.结论血清CA125水平升高也可见于一些盆腔良性肿物,主要有盆腔结核、子宫腺肌病、卵巢子宫内膜异位症及卵泡膜-纤维组肿瘤等,但其中位数值均明显低于卵巢上皮性癌.血清CA125水平检测有利于子宫肌瘤和子宫腺肌病的鉴别诊断.

Clinical analysis of benign pelvic mass with high serum levels of CA(125)

Objective To investigate serum CA_(125) levels and the value of serum CA_(125) in differential diagnosis of benign pelvic mass. Methods We retrospectively analyzed 492 patients with benign pelvic mass, including 237 cases of benign ovarian tumor and 255 other benign gynecological diseases. Sixty cases of ovarian epithelial cancer were randomly chosen as control group. Results The median of serum CA_(125) in patients with pelvic tuberculosis, uterine adenomyosis, ovarian endometriosis and ovarian fibroma were all higher than the cut-off level of CA_(125) (35 kU/L), being 465.0, 88.9,59.0 and 44.5 kU/L, respectively. Those of ovarian epithelial cancer patients were significantly higher than in benign pelvic mass (P<0.01). The highest value of CA_(125) among all the benign cases was 1281.0 kU/L, which was seen in a case of ovarian thecoma. The highest median value was 465.0 kU/L, detected in a patient with pelvic tuberculosis. Conclusions Serum CA_(125) levels in some benign pelvic mass are higher than the cut-off level of CA_(125), such as pelvic tuberculosis, uterine adenomyosis, ovarian fibroma and ovarian endometriosis. The medians of serum CA_(125) in benign pelvic mass are much lower than in ovarian epithelial cancer. Serum CA_(125) is of significance in the differential diagnosis between hysteromyoma and uterine adenomyosis.