血清HE4与卵巢癌临床诊断的相关性研究——附69例CA125比对分析

Significance of HE4 detection for diagnosis of ovarian cancer as compared with Cal25 in 69 cases

分别用ELISA法和电化学发光法测定手术前的69例卵巢癌患者和52卵巢良性肿瘤患者及60例健康体检者的HE4和CA125的血清水平,并以卵巢良性肿瘤+健康人为参照绘制ROC曲线,分析HE4和CA125在不同临界点时对卵巢癌的诊断能力,评价HE4和CA125的诊断价值。临床回顾卵巢癌患者临床分期和病理学参数,以单变量统计分析治疗前HE4和CA125水平与卵巢癌临床病理特征的相关性。结果显示卵巢癌组HE4的中位水平为233.40 pmol/L,CA125中位数水平为88.37 U/ml,与卵巢良性肿瘤组和正常对照组比较,差异有非常显著意义(P<0.01)。以良性肿瘤+健康人为参照人群,HE4和CA125单项检测的受试者工作特征曲线下面积分别为0.906和0.758,当HE4的阳性临界点为150 pmol/L时,其敏感性和特异性分别为68.12%和100%,当HE4的阳性临界值为75 pmol/L时,其敏感性和特异性分别为79.71%和94.64%。HE4和CA125的表达水平和阳性率与患者临床分期及病理特征显著相关。尤其在FIGOⅠ期卵巢癌患者,高分化卵巢癌患者以及卵巢子宫内膜样癌患者中,HE4的表达阳性率显著高于CA125,差异有统计学意义(P<0.05)。由此可见HE4作为卵巢癌的肿瘤标志物,具有比CA125更好的鉴别诊断和早期诊断价值,术前HE4和CA125的检测可辅助判断卵巢癌患者临床病理特征,提高术后生存率。

Sixty-nine serum samples from patients with ovarian cancer, 52 serum samples from patients with optimum ovarian disease and 60 serum samples from the normal controls were collected for this study. ELISA and ECF were used respectively to detect the concentrations of HE4 and CA125 for evaluating the diagnostic significance of HE4 and CA125 in ovarian cancer. The sensitivity of assay was evaluated by receiver operating characteristic-area under the curve （ROC-AUC）. The relation of HE4 and CA125 assay with pathological indexes was analyzed. The results showed that the median level of HE4 and CA125 were significantly higher in malignant ovarian tumor group than those in the optimum ovarian disease group and normal control group. The HE4 assay had advantage over the CA125 assay （0. 906 vs O. 758） in ROC-AUC as to the sensitivity（68.12 %） and specificity（100%）. The concentration and positive rate of both the HE4 and CA125 were related to clinical stages and patho- logical features. Especially, in well differentiated ovarian cancer patients（stage FIGO I） as well as ovarian endometrioid cancer patients, HE4 expression positive rate was significantly higher than CA125, the difference was statistically significant （P^0. 05）. These findings showed that, as a tumor marker for ovarian cancer, HE4 was better than CA125 with regard to differential diagnosis and early diagnosis, so preoperative detection of HE4 and CA125 can assist to determine the clinical pathological fea- tures of ovarian cancer patients and to improve postoperative survival.