尿/血清HE4比值在卵巢癌中的诊断价值

目的 通过检测血清人附睾蛋白4(S-HE4),尿人附睾蛋白4(U-HE4)及尿/血清HE4比值(R-HE4)的变化情况,探讨R-HE4比值在卵巢癌中的诊断价值.方法 选取135例年龄匹配的女性及卵巢癌患者,分别为卵巢癌组45例(OC组)、慢性肾病组40例(CKD组)及健康女性50例(HC组),分别检测85例患者及50例健康女性外周血清及尿中HE4水平(pmol/l)及糖类CA125水平(U/L),其中45例卵巢癌患者需术前检测血清和尿中HE4及血清中的CA125,HE4及CA125在OC,CKD及HC不同组间的检测值,分别绘制各组ROC曲线,计算各组敏感性、特异性,约登指数(Youden,s?index)评估不同HE4对卵巢癌的诊断预测价值.结果 各组间不同HE4水平两两比较:OC组与CKD组S-HE4比较差异无统计学意义(P=0.295);U-HE4和R-HE4中,任两组的各自HE4水平比较差异均有统计学意义(P=0.000);各组ROC曲线结果显示:OC组与CKD组中S-HE4其AUC=0.428,显示无法诊断鉴别OC与CKD患者(P=0.252);若设定R-HE4理想截断值范围其为24(OC与CKD),其诊断的敏感性、特异性及约登指数分别为:88.9%、95%、83.9%和82%、93.3%、75.3%.结论 R-HE4是一个有效可靠的诊断卵巢癌的独立指标.

Objective To study the diagnostic value of the ratio of R-HE4(the Ratio of urinary to serum human epididymis protein)by testing the serum HE4 and urinary HE4.Methods 135 case age matched women and patients who were grouped into ovarian cancer group(OC group,45case),chronic kidney disease group(CKD group,40 case)and healthy control group(HC group,50 case).The level of HE4 in serum and urinary in all 135 cases women and patients were tested,including preoperation in 45case OC patients.All statistical dates were performed by SPSS19.0 statistical software,difference between different group variables HE4(x±s)were evaluated by K independent sample nonparametric test(Krusakal-Wallis test and Mann-Whitney U test).The sensitivity,specificity and Youden,s index were calculated according to the ROC(receiver operating characteristic)curve,and the performance of prediction and diagnosis of OC were evaluated.Results S-HE4 between OC group and CKD group showed no significance,P=0.295.The comparison of different HE4 among different group showed great significance,P=0.000(P<0.001).The ROC curve of different HE4 among different groups showed great performance of prediction and diagnosis of ovarian cancer,except only between 45 cases OC and 40 cases CKD,AUC=0.428,P=0.252,however the R-HE showed great predictive and diagnostic performance between different group.If the ideal cutoff point of R-HE4 between OC and CKD was 24,sensitivity,specificity and Youden’s index were respectively,88.9%,95%,83.9%and 82%,93.3%,75.3%.Conclusion R-HE4 is an effective and reliable diagnosis of ovarian cancer independent marker.