血清α-羟基丁酸脱氢酶表达水平在卵巢癌辅助诊断中的应用

Exploration on the application value of the expression level of alpha-hydroxybutyrate dehydrogenase in the diagnosis of ovarian cancer

目的分析α-羟基丁酸脱氢酶(α-HBDH)在卵巢癌(OC)患者血清中的表达水平,并探讨其在OC诊断中的应用价值。方法采用回顾性研究方法,收集2014年1月至2018年8月浙江大学医学院附属妇产科医院确诊治疗的OC患者319例作为OC组,同期选取卵巢良性病变患者400例为良性组及健康体检者400名为正常组,每组进一步分为未绝经组和绝经组,统计分析所有研究对象血清α-HBDH和糖类抗原125(CA125)的表达水平,分析其与OC临床、病理参数的关系、两种指标在OC的诊断效能。两组间比较采用Wilcoxon秩和检验,多组间比较采用Kruskal-Wallis H检验。绘制受试者工作特征(ROC)曲线评价所观察指标的诊断性能。结果血清α-HBDH水平(中位数)在OC组为134.0 U/L,良性组为120.0 U/L,正常组为110.0 U/L。OC组与其他2组之间比较,差异有统计学意义(H=129.5,P<0.001)。血清α-HBDH水平与OC患者是否绝经、临床分期、有无淋巴结转移相关(Z=-5.2,P<0.001;H=31.5, P<0.001;Z=-3.2, P<0.001)。ROC曲线分析表明,α-HBDH对OC的诊断性能低于CA125[未绝经组(α-HBDH:曲线下面积(AUC)=0.685;CA125:AUC=0.796);绝经组(α-HBDH:AUC=0.749;CA125:AUC=0.915)];在Ⅰ期OC的诊断性能中,α-HBDH在非绝经组中的诊断性能与CA125接近,但敏感度却明显高于CA125(α-HBDH:AUC=0.646,敏感度=79.41%,特异度=41.61%;CA125:AUC=0.691,敏感度=58.82%,特异度=74.71%)。结论血清α-HBDH水平在OC患者中表达升高,且与是否绝经、临床分期、有无淋巴结转移相关,其在Ⅰ期OC未绝经组中比CA125具有更高的敏感度,有助于Ⅰ期未绝经患者的诊出。

Objective This study analyzed the expression of alpha-hydroxybutyrate dehydrogenase (α-HBDH) in serum and explored its predicative value in the diagnosis of ovarian cancer (OC). Methods A retrospective study was conducted on 319 OC patients (OC group), 400 patients with benign lesions (benign group), and 400 healthy controls (normal group). These subjects were treated or received physical examination in Women′s Hospital, School of Medicine, Zhejiang University from January 2014 to August 2018. Each group was further stratified by menopausal status. The expression levels of α-HBDH and carbohydrate antigen125 (CA125) and their associations with clinic-pathological characteristics of OC were evaluated, and their diagnostic efficacy in OC were explored. Wilcoxon Rank Test and Kruskal-Wallis H test were used for group comparison. Receiver operating curve (ROC) was plotted to evaluate the diagnostic capability of α-HBDH and CA125 in OC. Results The median of α-HBDH level was 134.0 U/L in OC group, 120.0 U/L in benign group, and 110.0 U/L in normal group. OC group was significantly different from other two groups (H=129.5, P<0.001). Serum α-HBDH was also correlated with the menopausal status, lymph node metastasis, and clinical stage of OC patients significantly (Z=-5.2, H= 31.5,Z=-3.2,all P<0.001). In the ROC analysis in terms of OC risk, the area under curve (AUC) ofα-HBDH was lower than AUC of CA125 [premenopausal group (α-HBDH: AUC=0.685;CA125: AUC=0.796;menomenopausal group (α-HBDH: AUC=0.749;CA125: AUC=0.915)];and in the stage I of premenopausal group,α-HBDH performed similar to CA125, but with obviously higher sensitivity than CA125 (α-HBDH: AUC:=0.646, Se=79.41%, SP=41.61%;CA125: AUC=0.691, Se=58.82%, Sp=74.71%). Conclusions The expression level of serum α-HBDH level was increased in OC patients, and it was associated with menopausal stage, lymph node metastasis, and clinical stage of OC. In addition,α-HBDH showed higher sensitivity than CA125 in stage I premenopausal group, which was potentially beneficial for the diagnosis of stage I OC in premenopausal women.