血清人附睾蛋白4检测在非小细胞肺癌诊断中的临床意义

Clinical significance of serum human epididymis protein 4 detection in the diagnosis of non-small cell lung cancer

目的探讨血清人附睾蛋白4(HE4)对非小细胞肺癌(NSCLC)的诊断意义。方法选择2013年1月至2015年1月徐州医学院附属连云港医院进行手术治疗的96例NSCLC患者为观察组,另选同期96例健康体检者为对照组,检测两组血清HE4水平,比较手术前不同临床病理特征NSCLC患者血清HE4水平差异。以病理诊断为金标准,绘制血清HE4、血清癌胚抗原(CEA)、细胞角蛋白21-1(CYFRA21-1)对NSCLC诊断的ROC曲线。结果观察组患者手术前血清HE4水平显著高于对照组,差异有统计学意义(P<0.05),且显著高于手术后水平,差异有统计学意义(P<0.05)。手术前不同TNM分期的血清HE4表达水平差异有统计学意义(P<0.05),其中Ⅲ期患者HE4水平显著高于Ⅰ期和Ⅱ期患者,差异有统计学意义(P<0.05)。当血清中HE4、CEA和CYFRA21-1浓度分别为67.75 pmol/L和2.49 ng/ml,2.53 ng/ml时,对NSCLC有最大诊断价值,曲线下面积(AUC)分别为0.887,0.840和0.711。HE4检测灵敏度显著高于CEA和CYFRA21-1,差异有统计学意义(P<0.05)。结论与CEA和CYFRA21-1比较,血清HE4对NSCLC的诊断有较高的敏感性,对NSCLC早期诊断、疗效评估和病情监测具有重要价值。

Objective To explore the clinical significance of serum human epididymis protein 4（ HE4） detection in the diagnosis of non-small cell lung cancer（ NSCLC）. Methods A total of 96 NSCLC patients from Lianyungang Hospital affiliated to Xuzhou Medical College undergoing operation were selected as observation group and 96 healthy people of the corresponding period were selected as control group from January 2013 to January 2015. Serum HE4 levels were detected in both groups,and difference in the serum HE4 levels were compared in NSCLC patients with different clinical pathological characteristics before operation. Pathological diagnosis result was considered as gold standard,ROC curves of HE4,carcinoma-embryonic antigen（ CEA） and cytokeratin protein 19 fragments（ CYFRA21-1） in the diagnosis of NSCLC were plotted. Results The serum HE4 level in the observation group before operation was higher than the control group（ P 〈 0. 05）,especially higher than after operation（ P 〈 0. 05）. There was statistically significant difference in the serum HE4 levels in patients in different TNM stages before operation（ P 〈 0. 05）,in which HE4 levels were higher in patients with Ⅲ stage than in patients withⅠand Ⅱ stage（ P 〈 0. 05）.The diagnostic value reached to the maximum points when the level of serum HE4,CEA,CYFRA21-1 was67. 75 pmol / L,2. 49 ng / ml and 2. 53 ng / ml respectively,and the corresponding area under curve（ AUC）was 0. 887,0. 840 and 0. 711. The sensitivity of serum HE4 was significantly higher than CEA and CYFRA21-1（ P 〈 0. 05）. Conclusion Compared with serum CEA and CYFRA21-1,serum HE4 has high sensitivity in the diagnosis of NSCLC,which has important value for the early diagnosis,efficacy evaluation and disease monitoring of NSCLC.