人附睾分泌蛋白4与糖类抗原125对卵巢肿瘤的诊断价值

The diagnostic value of human epididymis protein 4 and carbohydrate antigen 125 for patients with ovarian neoplasms

目的：探讨人附睾分泌蛋白4（HE4）和糖类抗原125（CA125）的检测对卵巢肿瘤患者的诊断价值。方法采用酶联免疫法检测1109例卵巢肿瘤患者的HE4和CA125的值，评估单一和联合检测的敏感性和特异性。结果①绝经后卵巢肿瘤患者HE4、CA125水平均高于未绝经卵巢肿瘤患者（t＝8．40，P＜0．05；t＝7．02，P＜0．05）；卵巢肿瘤患者生育胎数越多，HE4及CA125水平越高，差异有统计学意义（F＝15．36，P＜0．05；F＝13．00，P＜0．05）。②卵巢癌患者HE4水平高于交界性及卵巢良性疾病患者，差异有统计学意义（t＝13．68，P＜0．05；t＝14．94，P＜0．05）；卵巢癌患者的CA125水平高于交界性及卵巢良性疾病患者（t＝14．16，P＜0．05；t＝17．27，P＜0．05）；有腹腔积液和脉栓者HE4水平明显高于无腹腔积液和脉栓者（t＝7．08，P＜0．05；t＝4．41，P＜0．05）；有腹腔积液和脉栓者CA125水平明显高于无腹腔积液和脉栓者（t＝9．67，P＜0．05；t＝4．75，P＜0．05）。③术后3个月随访230例患者，其HE4、CA125水平明显低于术前，差异有统计学意义（t＝9．86，P＜0．05；t＝5．12，P＜0．05）。④HE4、CA125、卵巢恶性肿瘤风险计算法（ROMA ）值的接受者操作特性曲线（ROC ）下面积无明显差异。⑤CA125的敏感性高于 HE4，但其特异性低于 HE4，HE4＋CA125联合检测敏感性高于单一检测及ROMA值，特异性低于单一检测及 ROMA 值。按绝经状态分组后的 ROMA 值具有更高的敏感性（73．84％，84．19％）和较低的特异性（66．06％，66．67％）。结论对于卵巢肿瘤患者，CA125的敏感性高，HE4的特异性高，联合检测可进一步提高诊断的敏感性及准确性。

Objective Toevaluatethediagnosticvalueofhumanepididymisprotein4（HE4）andcar-bohydrate antigen 1 25 （CA1 25 ）for distinguishing between benign and malignant ovarian neoplasms.Methods 1 1 09 patients with ovarian neoplasms were enrolled in this study,serum concentration of HE4 and CA1 25 was assayed using ELISA technique.And the markers were evaluated for significance separately and in combination. Results 1SerumlevelsofHE4andCA125weresignificantlyhigherinpost-menopausalwomenthanthosein pre-menopausal women（t=8.40,P〈0.05;t=7.02,P〈0.05）.In addition,the more children the patients born,the higher serum levels of these two markers were（F=1 5.36,P〈0.05;F=1 3.00,P〈0.05）.2 Serum HE4 levels were significantly higher in the ovarian cancer patients compared with those seen in patients with benign or borderline tumor（t=1 3.68,P〈0.05;t=1 4.94,P〈0.05）.Serum CA1 25 levels were significantly higher in the ovarian cancer patients compared with those seen in patients with benign or borderline tumor（t=1 4.1 6,P〈0.05;t=1 7.27,P〈0.05）.Morever,it also appared in the ovarian cancer patients with ascites and vascular embolism.Morever,the levels of HE4 were significantly higher in the ovarian cancer with ascites and vascular embolism than without it（t=7.08,P〈0.05;t=4.41,P〈0.05）,the levels of CA125 were signifi-cantly higher in the ovarian cancer with ascites and vascular embolism than without it（t=9.67,P〈0.05;t=4.75,P〈0.05）.3 During follow-up,serum HE4 and CA1 25 levels significantly decreased at 3 months after＆amp;nbsp;operation（t=9.86,P〈0.05;t=5.12,P〈0.05）.4 Receiver operating characteristic curve,ROC）analysis revealed that no difference was observed in AUC values for HE4,CA1 25 and risk of ovarian malignancy algo-rithm（ROMA）.5 Compared to CA1 25 ,HE4 had significantly higher specificity and lower sensitivity.Howev-er,sensitivity were increased when the two markers were combined with each other.However,the sensitivity of combination with two markers was higher than single detection and ROMA,but the specificity was lower in com-bination with two markers than single detection and ROMA.If we divide the ROMA by a woman′s menopausal status,ROMA has a higher sensitivity （73.84%,84.1 9%） and lower specificity （66.06%,66.67%）. Conclusions ThelevelsofCA125hasahighsensitivity,andthelevelsofHE4isahighspecificity.CA125 combined with HE4 can provide a more sensitivity and accurate predictor of ovarian cancer than either alone.