血清人附睾分泌蛋白4和糖链抗原125联合检测在卵巢癌诊断中的应用

Combined detection of HE4 and CA125 in diagnosis of ovarian cancer

目的:探讨肿瘤标志物附睾分泌蛋白4(HE4)和糖链抗原125(CA125)联合检测在卵巢癌的诊断和鉴别诊断中的应用价值。方法:以电化学发光法检测36例卵巢癌和45例妇科良性疾病患者血清CA125,用酶免疫(EIA)法检测其HE4水平,另设60名健康体检女性为对照组,分析和比较肿瘤标志物在不同组别血清中的水平及各组单项指标和联合检测的阳性率。结果:卵巢癌组患者的血清HE4、CA125水平均显著高于妇科良性疾病组和对照组(P<0.05)。HE4、CA125的单项检测阳性率分别为55.56%和50.00%,联合检测阳性率为69.44%,较单项检测有提高,但准确度基本不变。单项检测时,分别以正常组、妇科良性疾病组和妇科良性疾病组+正常组作参照人群,HE4单项检测受试者工作特征(ROC)曲线下面积(AUC)分别为0.736、0.744、0.740,CA125单项检测的ROCAUC分别为0.717、0.683、0.702。HE4+CA125联合检测的ROCAUC分别为0.789、0.747、0.771。当血清HE4临界值点为52.39pmol/L时,其灵敏度均较临界值点为64和84pmol/L时有所升高,但特异度和阳性预测值明显下降。当临界值点为84pmol/L时,HE4检测卵巢癌恶性肿瘤的特异度达到100%。结论:HE4是较灵敏的卵巢癌血清标志物,和CA125联合检测有助于提高卵巢癌的检出率和诊断性能。

Objective To study the value of combined detection of cancer-associated carbohydrate antigen 125 （CA125）and human epididymis protein 4 （HE4）in the diagnosis of ovarian cancer. Methods Serum levels of CA125 and HE4 in 36 patients with ovarian cancer,45 patients with gynecological benign diseases and 60 healthy women were determined by electrochemiluminescence assay（ECLI）and enzyme immunoassay （EIA）. Results Serum levels of CA125 and HE4 in ovarian cancer group were significantly higher than that in the gynecological benign diseases group and healthy women group （P0.05）. The positive rates of HE4 and CA125 tests were 55.56% and 50.00%,respectively, and the positive rate of combined detection （69.44%） was higher than that of single test, however, the accuracy was unchanged. Using healthy women, gynecological benign diseases, and gynecological benign diseases plus healthy women groups as the reference groups, the AUC of ROC in HE4 single detection were 0.736,0.744,0.740,respectively, that in CA125 single detection were 0.717,0.683、0.702, respectively, and that in combined detection of HE4 and CA125 were 0.789,0.747,0.771, respectively. When the cutoff point of serum HE4 was set at 52.39 pmol/L, the sensitivity was higher than the cutoff point was set at 64 or 84 pmol/L, but the specificity and positive predictive value were decreased. When the cutoff point was set at 84 pmol/L, the specificity of HE4 test for ovarian cancer was 100%. Conclusions Combined detection of CA125 and HE4 can increase the detection rate and improve the diagnosis of ovarian cancer.