CA125、HE4、AngⅡ联合检测诊断子宫内膜癌

Value of combined detectin of tumor markers in diagnosis of primary endometrial carcinoma

目的:探讨糖链抗原125(CA125)、附睾蛋白4(HE4)和血管紧张素Ⅱ(Ang Ⅱ)单检以及联合检测在子宫内膜癌(endometrial cancer,EC)诊断的应用价值。方法:搜集2013年1月至2014年11月在中国医科大学附属盛京医院就诊的130例EC患者作为实验组以及46例健康女性作为对照组。检测其CA125表达水平。同时应用酶联免疫试验(ELISA)技术对血清中HE4、Ang Ⅱ表达水平进行检测,分析三种肿瘤标记物单独检测时各自的灵敏度、特异度的优、缺势,及联合检测时灵敏度和特异度否有所提升。结果:实验组血清中CA125、HE4、Ang Ⅱ的表达水平分别是34.33±14.45、78.19±32.31、13.82±5.42,而对照组中其表达水平分别为13.30±9.22、45.61±15.70、7.70±3.58,EC组血清CA125、HE4、Ang Ⅱ明显高于对照组,分别比较,差异均有统计学意义(P<0.05)。CA125、HE4、Ang Ⅱ在EC的I-Ⅱ期组阳性率分别为37.27%、47.27%、7.27%;ⅡI-IV期组阳性率分别为60%、70%、35%,对比三者各自的阳性率发现,在早期三者的诊断率均较晚期低;将其按年龄分为<60岁、≥60岁,CA125、HE4、Ang Ⅱ三者在<60岁组的阳性率分别为46.15%、32.69%、9.61%;在≥60岁组的阳性率分别为37.18%、70.78%、24.37%,对比发现,CA125在年龄方面无明显区别,而HE4、Ang Ⅱ在年龄方面却有显著差异;CA125、HE4、Ang Ⅱ三者检测的灵敏度分别为49.23%、52.31%、46.15%,三者联检的灵敏度为86.15%;CA1 2 5、HE4、Ang Ⅱ三者检测的特异度分别为89.30%、91.65%、85.65%,三者联检的特异度为73.60%,联合检测可以提高诊断的灵敏度,但特异度却相对降低。结论:单项肿瘤标记物在子宫内膜癌中的诊断价值具有一定的局限性,但3项联合检测可有效提高子宫内膜癌的诊断性能及早期检出率,是检测子宫内膜癌的较为理想的标志物组合。

Objective： To study the value of the combined tests of mean carbohydrate antigen125（ CA125） 、Epididymis protein 4（ HE4） and An-giotensin Ⅱ（ Ang Ⅱ） for the diagnosis of endometrial cancer. Methods： From Jan2013 to Nov 2014,the serum specimens were collected from 130 cases of endometrial carcinoma（ the experimental group） and 46 casesof healthy women（ the control group）. CA125 levels in the serum were detected from our hospital and HE4,Ang Ⅱ levels in the serum were detected by ELISA. Results： The levels of Ang Ⅱ in patients with endometrial carcinoma were significantly higher than those in healthy controls（ P〈0. 05）. The levels of CA125、HE4、Ang Ⅱ in patients with endometrial carcinoma were significantly higher than those in healthy controls（ P〈0. 05）. The positive rate of CA125,HE4,Ang Ⅱ were all obviously higher in EC patients at stage I and Ⅱ than in those at stage ⅡI and IV.CA125 had no obvious difference in of age,and HE4,Ang Ⅱ had significant difference in age. CA125,HE4 and Ang Ⅱ detection sensitivity were 49. 23%,52. 31% and 46. 15% respectively. The sensitivity of the three joint inspection was 86. 15%. Detection of CA125,HE4,Ang Ⅱ three specific degrees were 89. 30%,91. 65% and 85. 65% respectively. Three joint inspection was 73. 60%,the joint detection can improve the sensitivity of diagnosis,but specific degree was relatively lower. Conclusion： The value of single tumor marker detection in the early diagnosis of EC is limited. The combined detection of CA125,HE4,Ang Ⅱ is beneficial to improving the diagnosis performance as well as to increasing the early diagnosis rate for EC. The combined det-ection of CA125,HE4,Ang Ⅱ is an ideal marker combination in the dete-ction of EC.