老年上皮性卵巢癌患者血清人附睾上皮分泌蛋白4的变化及临床意义

Change and its clinical significance of serum level of human epididymis secretory protein 4 in elderly patients with epithelial ovarian cancer

目的 探讨老年上皮性卵巢癌患者血清中人附睾上皮分泌蛋白4（human epididymis protein 4,HE4）的改变及其临床意义.方法 用ELISA法检测老年上皮性卵巢癌33例、良性卵巢疾病17例及老年健康女性20例血清HE4水平,另选同期非老年上皮性卵巢癌患者31例及健康女性20例为对照,同时测定糖类抗原125（CA125）.结果 健康人群中≥60岁组血清HE4水平（32.25±13.15）pmol/L高于＜60岁组（24.59±8.60）pmol/L,血清HE4水平与年龄呈显著正相关（r=0.525,P＜0.01）.老年组中上皮性卵巢癌患者血清HE4水平明显高于卵巢良性疾病患者（中位数81.50 pmol/L对45.60 pmol/L,U=168.5,P＜0.05）和健康对照者（中位数81.50 pmol/L对33.30 pmo1/L,U=76.5,P＜0.01）;根据受试者操作特性曲线（ROC曲线）分析,HE4检测老年上皮性卵巢癌的临界值为65.43 pmol/L时,其敏感度为66.67%,特异性为86.49%,与CA125相比曲线下面积为0.799比0.782,HE4诊断价值稍高于CA125;老年与非老年上皮性卵巢癌患者血清HE4水平比较,差异无统计学意义（U=404.2,P＞0.05）.结论 年龄是影响人血清HE4水平的重要生理因素,HE4测定有助于老年人上皮性卵巢癌的诊断,与CA125联合检测,可显著提高诊断的准确性.

Objective To investigate the change and clinical significance of the serum level of human epididymis secretory protein 4 （HE4） in elderly patients with epithelial ovarian cancer （EOC）.Methods The serum levels of HE4 were determined by ELISA in EOC patients （n= 33）, benign ovarian disease patients （ n = 17） and healthy women （ n = 20）, all of them aged 60 years or over. And there were other 31 EOC patients and 20 healthy women aged less than 60 years at the same period as controls. Results In healthy people, the serum level of HE4 was higher in the group with age ≥60 years than with age 〈60 years [（32.25± 13. 15） pmol/L vs. （24.59±8.60） pmol/L]. The serum HE4 level had a positive correlation with age （r=0. 525, P〈0.01）. The median level of HE4 was significantly higher in elderly EOC patients than in benign ovarian disease patients （81.50 pmol/L vs.45.60 pmol L, U=168.5, P〈0.05） and healthy women （81.50 pmol L vs. 33.30 pmol L, U=76.5, P〈0. 01）. The HE4 had a significantly higher area under ROC curve when compared with CA125 （0. 799 vs. 0. 782）, while the cut-off value was set 65.43 pmol L with a sensibility and specificity of 66.67% and 86.49% respectively. The diagnostic efficacy of HE4 was higher than CA125. There was no significantly statistical difference between elderly and non-elderly EOC patients in serum HE4 levels （U= 101.2, P〉0. 05）. Conclusions Age is an important factor which can affect human serum level of HE4. HE4 determination is helpful in the diagnosis of ovarian epithelial carcinoma in the elderly patients, and the combined detection of HE4 and CA125 is an useful adjuvant diagnostic measure.