血清人附睾分泌蛋白4、糖类抗原125和脂联素在子宫内膜癌淋巴结转移诊断中的价值

Value of serum human epididymis protein 4,carbohydrate antigen 125 and adiponectin in the diagnosis of lymphatic metastasis in patients with endometrial carcinoma

目的血清人附睾分泌蛋白4(HE4)、糖类抗原125(CA125)及脂联素在子宫内膜癌淋巴结转移诊断中的价值。方法选择2011年12月至2014年6月在咸宁市中心医院接受治疗的子宫内膜癌患者82例,其中伴淋巴结转移47例(观察组),无淋巴结转移35例(对照组)。对2组患者血清HE4、CA125及脂联素水平进行比较,并分析血清HE4、CA125及脂联素在子宫内膜癌淋巴结转移诊断中的价值。结果观察组患者血清HE4和CA125水平显著高于对照组(P<0.05),血清脂联素水平显著低于对照组(P<0.05)。受试者工作特征曲线分析显示,以血清HE4水平为170.6 pmol·L^(-1)作为临界值,其对子宫内膜癌伴淋巴结转移诊断的敏感度为47.27%,特异度为77.78%;以血清CA125水平为40.69 k U·L^(-1)作为临界值,其对子宫内膜癌伴淋巴结转移诊断的敏感度为23.40%,特异度为91.43%;以血清脂联素水平为7.13 mg·L^(-1)作为临界值,其对子宫内膜癌伴淋巴结转移诊断的敏感度为44.68%,特异度为81.35%;血清HE4、CA125和脂联素联合检测对子宫内膜癌伴淋巴结转移诊断的敏感度为65.47%,特异度为89.02%。血清HE4与脂联素对子宫内膜癌伴淋巴结转移诊断的敏感度和特异度比较差异均无统计学意义(P>0.05);血清HE4和脂联素对子宫内膜癌伴淋巴结转移诊断的敏感度高于CA125(P<0.05),特异度低于CA125(P<0.05);血清HE4、CA125和脂联素联合检测对子宫内膜癌伴淋巴结转移诊断的敏感度均高于单独检测血清HE4、CA125及脂联素(P<0.05)。血清HE4、CA125和脂联素联合检测对子宫内膜癌伴淋巴结转移诊断的特异度高于单独检测血清HE4和脂联素(P<0.05),但三者联合检测与单独检测CA125对子宫内膜癌伴淋巴结转移诊断的特异度比较差异无统计学意义(P>0.05)。结论血清HE4、CA125和脂联素可作为诊断子宫内膜癌伴淋巴结转移的肿瘤标志物,三者联合检测对诊断子宫内膜癌淋巴结转移具有较高价值。

Objective To investigate the value of serum human epididymis protein 4（ HE4）,carbohydrate antigen 125（ CA125） and adiponectin in the diagnosis of lymphatic metastasis in patients with endometrial carcinoma. Methods A total of 82 cases of endometrial cancer were selected in Xianning Central Hospital From December 2011 to June 2014,including 47 patients with lymphatic metastasis（ observation group）,35 patients without lymphatic metastasis（ control group）. The levels of serum HE4,CA125 and adiponectin were compared between the two groups,and the value of serum HE4,CA125 and adiponectin in the diagnosis of lymphatic metastasis in patients with endometrial carcinoma. Results The levels of serum HE4 and CA125 in observation group were significantly higher than those in control group（ P 0. 05）,but the level of serum adiponectin in observation group was significantly lower than that in control group（ P 0. 05）. Receiver operating characteristic curve analysis showed that the sensitivity and specificity of serum HE4 in diagnosing lymphatic metastasis in patients with endometrial carcinoma was 47. 27% and 77. 78% respectively when 170. 6 pmol·L^（-1）was selected as the critical value of serum HE4.The sensitivity and specificity of serum CA125 in diagnosing lymphatic metastasis in patients with endometrial carcinoma was23. 40% and 91. 43% respectively when 40. 69 k U·L^（-1）was selected as the critical value of serum CA125. The sensitivity and specificity of serum adiponectin in diagnosing lymphatic metastasis in patients with endometrial carcinoma was 44. 68%and 81. 35% respectively when 7. 13 mg·L^（-1）was selected as the critical value of serum adiponectin. The sensitivity and specificity of the combined detection of serum HE4,CA125 and adiponectin in diagnosing lymphatic metastasis in patients with endometrial carcinoma was 65. 47% and 89. 02% respectively. There was no significant difference in the sensitivity and specificity between serum HE4 and adiponectin in diagnosing lymphatic metastasis in patients with endometrial carcinoma（ P 0. 05）.The sensitivity of serum HE4 and adiponectin in diagnosing lymphatic metastasis in patients with endometrial carcinoma was higher than that of serum CA125（ P 0. 05）,but the specificity of serum HE4 and adiponectin was lower than that of serum CA125（ P 0. 05）. The sensitivity of combined detection of serum HE4,CA125 and adiponectin in diagnosing lymphatic metastasis in patients with endometrial carcinoma was higher than that of any one of serum HE4,CA125 and adiponectin（ P 0. 05）. The specificity of combined detection of serum HE4,CA125 and adiponectin in diagnosing lymphatic metastasis in patients with endometrial carcinoma was higher than that of any one of serum HE4 and adiponectin（ P 0. 05）. But there was no significant difference in the specificity between the combined detection of the three indexes and CA125 in diagnosing lymphatic metastasis in patients with endometrial carcinoma（ P 0. 05）. Conclusions Serum HE4,CA125 and adiponectin can be used as tumor markers for diagnosing lymphatic metastasis in patients with endometrial carcinoma. Combined detection of the three indexes has a high value in diagnosing lymphatic metastasis.