CA125、HE4及OPN联合检测对卵巢癌的诊断价值

Combination of Serum CA125,HE4and OPN in the Diagnosis of Ovarian Cancer

目的:探讨癌抗原-125(cancer antigen 125,CA125)联合人附睾分泌蛋白4(human epididymis secretory protein 4,HE4)和骨桥蛋白(osteopontin,OPN)检测对卵巢癌的诊断价值。方法:对2009年1月—2009年12月上海市第七人民医院和复旦大学附属肿瘤医院经病理证实为卵巢上皮癌的患者30例(卵巢癌组)、卵巢良性肿瘤患者30例(良性肿瘤组)及患子宫肌瘤等妇科疾病但卵巢正常者30例(正常组),采用微粒子化学发光法检测血清CA125、ELISA法检测血清HE4、OPN,绘制受试者工作特征(receiver operator characteristic,ROC)曲线,计算曲线下面积(area under the curve,AUC),评价各标志物单独和联合检测用于卵巢癌诊断的价值。结果:卵巢癌患者血清CA125、HE4、OPN水平显著高于良性肿瘤组及正常组(P<0.01),而良性肿瘤组与正常组之间差异无统计学意义(P>0.05)。与正常组及良性肿瘤组比较,检测CA125、HE4、CA125+HE4、CA125+OPN和CA125+HE4+OPN用于卵巢癌诊断时,其ROC曲线下AUC分别为0.80、0.85、0.90、0.86、0.91;在特异度为90%时,各指标敏感度依次为56.6%、73.3%、80%、76.6%、83.3%,阳性预测值依次为0.73、0.79、0.80、0.79、0.81,阴性预测值依次为0.81、0.87、0.90、0.89、0.92,约登指数依次为0.466、0.633、0.700、0.666、0.733。结论:CA125、HE4、OPN3种肿瘤标志物在联合检测时对卵巢癌的诊断价值最高,但与CA125+HE4相当。

Objective：To evaluate the value of cancer antigen125（CA125）combined with human epididymis secretory protein4（HE4）and osteopontin（OPN）in diagnosing ovarian cancer.Methods：The level of CA125 was measured by automatic chemiluminescence analysis system,while HE4 and OPN were measured by enzyme-linked immunosorbent assay（ELISA）.There were three groups in this study,with 30 patients in ovarian cancer group,30 patients in ovarian benign tumor group and 30 patients with normal ovarian in normal group.The levels of serum markers in the three groups were compared.Sensitivity of assay was evaluated.The receiver operator characteristic（ROC）curves were drawn and areas under the curve（AUC）were calculated.Results：（1）The levels of CA125,HE4 and OPN in ovarian cancer group were significantly higher than those in ovarian benign tumor group and normal group（P〈0.01）,but there were no significant differences between ovarian benign tumor group and normal group（P〈0.05）.（2）Comparing with benign diseases（including the ovarian benign tumor group and normal group）,AUC of CA125 was 0.80（95%CI：0.77-0.83）;AUC of HE4 was 0.85（95%CI：0.81-0.89）;AUC of CA125＋HE4 was 0.90（95%CI：0.86-0.94）;AUC of CA125＋OPN was 0.86（95%CI：0.82-0.90）;AUC of CA125＋HE4＋OPN was 0.91（95%CI：0.86-0.96）.The sensitivities were 56.6%,73.3%,80%,76.6%,83.3%,respectively;the positive predictive values were 0.73,0.79,0.80,0.79,0.81,respectively;the negative predictive values were 0.81,0.87,0.90,0.89,0.92,respectively;Youden indexes were 0.466,0.633,0.700,0.666,0.733,respectively.Conclusions：The combination of the three markers has the highest diagnostic value in diagnosing ovarian cancer,but the value is similar to the combined use of CA125 and HE4.