血清HE4、CYFRA21—1、CA199在诊断卵巢良、恶性肿瘤中的价值

Value of serum HE4, CYFRA21-1, CA199 in the diagnosis of ovarian benign and malignant tumor

目的 探讨血清人附睾蛋白4（HE4）、细胞角蛋白19片段（CYFRA211）、糖类抗原199（CA199）对卵巢恶性肿瘤诊断的意义，评价其单独及联合检测在判断卵巢癌高风险中的价值。方法 采用电化学发光免疫法（ECL）检测威海市妇幼保健院就诊的45例原发性卵巢癌、56例良性卵巢肿瘤患者及50例健康体检女性血清中HE4、CYFRA211、CA199水平，分析三者在卵巢癌诊断中的阳性率及符合率，比较3种指标对卵巢肿瘤的诊断价值。结果 血清HE4在恶性肿瘤组与良性肿瘤组之间、恶性肿瘤组与对照组之间差异均有统计学意义（Z=-8.61，P＜0.001；Z=-8.39，P＜0.001）;CYFRA211在恶性肿瘤组与良性肿瘤组之间，恶性肿瘤组与对照组差异有统计学意义（Z=-8.60，P＜0.001；Z=-8.39，P＜0.001），HE4、CYRA211良性肿瘤组与对照组比较差异无统计学意义（Z=-1.31，P=0.189; Z=-1.29，P=0.191）;CA199在良性肿瘤组与对照组比较差异有统计学意义（Z=-8.79，P＜0.001），对于恶性肿瘤两者诊断的特异性和阳性预测值都很高（HE4为99.8%、99.7%, CYFRA211为99.0%、96.7%），HE4、CYFRA211诊断的符合率也比较高，分别为93.4%、88.7%，但两者的敏感性比CA199低。CA199在卵巢良、恶性肿瘤中都会升高，只是升高的程度不同，但对卵巢癌诊断的特异性不是很高（85.8%），阳性预测值和诊断符合率也比较低（70.6%、84.1%），三者联合检测则可以提高卵巢癌诊断的敏感性（100%）及准确性（89.4%）。结论 HE4、CYFRA211只在恶性卵巢肿瘤中升高，主要用于卵巢癌的诊断；CA199在良、恶性卵巢肿瘤中都有升高，但升高的程度不同，可用于良、恶性肿瘤的诊断与鉴别，三者联合检测则可提高卵巢癌诊断的敏感性和准确率，对于卵巢癌的早期诊断与治疗监测有重要的意义。

ObjectiveTo investigate the diagnosis significance of human epididymis （HE4）, cytokeratin19fragment （CYFRA211）, carbohydrate antigen 199 （CA199） on the malignant ovarian tumor, and to evaluate the value of individual and combined detection in judging high risk ovarian cancer. MethodsThe serum HE4, CYFRA211, CA199 levels of 45 patients with primary ovarian cancer, 56 patients with benign ovarian tumor and 50 healthy checkup women in our hospital were detected by electrochemiluminescence immunoassay （ECL）.The positive rates and coincidence rates of them were analyzed and the diagnostic value of them were compared.ResultsHE4 and CYFRA211 levels of ovarian cancer group were significantly higher compared with the benign tumor group and healthy control group and the differences were statistically significant （Z=-8.61,P〈0.001;Z=-8.39,P〈0.001; Z=-8.60,P〈0.001;Z=-8.39,P〈0.001）, however there is no difference between benign tumor group andcontrol group（Z=-1.31,P=0.189; Z=-1.29,P=0.191）. The difference of CA199 between benign tumor group and control group was statistically significant （Z=-8.79,P〈0.001）.For the malignant tumors, the specificity and positive predictive value of HE4 （99.8%, 99.7%）, CYFRA211 （99.0%, 96.7%） were very high and the diagnostic accordance rates were relatively high （93.4%, 88.7%）, but the sensibilities of them were lower compared with CA199.CA199 was increased both in benign and malignant ovarian tumors with different degrees, but the specificity was not very high （85.8%）, and the positive predictive value and the diagnosis accordance rate were low （70.6%, 84.1%）. The combined detection of HE4, CYFRA 211 and CA199 could improve the sensitivity and of the diagnosis of ovarian cancer （100%） and accuracy （89.4%）.ConclusionsHE4 and CYFRA211 only increas in malignant ovarian tumors, and they are mainly used for the diagnosis of ovarian cancer; CA199 level is increased both in benign and malignant ovarian tumors, but the extent is different and it can be used for distinguishing and diagnosing of benign and malignant ovarian tumors. Combining the three indexes can improve the sensitivity and accuracy of the diagnosis of ovarian cancer, and has an important significance for the early diagnosis and treatment of ovarian cancer.