术前血清CA125、HE4和中性粒细胞与淋巴细胞比值联合检测在子宫内膜癌诊断中的作用

The role of combined detection of preoperative serum CA125,HE4 and neutrophil-lymphocyte ratio in the diagnosis of endometrial cancer

目的:探讨血清糖类抗原125(carbohydrate antigen 125,CA125)、人附睾蛋白4(human epididymis protein 4,HE4)、中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)联合检测在子宫内膜癌诊断中的作用。方法:选取42例子宫内膜癌患者、50例子宫内膜良性疾病患者和50例健康体检人群。采用SYSMEX XN550全自动血液分析仪计数术前外周血中性粒细胞和淋巴细胞,计算NLR;采用Maglumi4000全自动化学发光仪检测术前血清CA125、HE4水平。采用ROC曲线分析CA125、HE4、NLR和三者联合指标在诊断子宫内膜癌中的作用。结果:外周血NLR在健康组、良性组和子宫内膜癌组中逐渐增高,且差异有统计学意义(P<0.05);子宫内膜癌组HE4表达量显著高于良性组与健康组(P<0.05),而良性组与健康组之间差异无统计学意义(P>0.05);CA125表达量在三组中差异无统计学意义(P>0.05)。CA125、HE4、NLR及三者联合标记物的AUC分别为0.530、0.733、0.795、0.823,当分别取它们的临界值时,特异性分别为70.8%、85.1%、61.7%、83.0%,敏感性分别为40.0%、63.3%、86.7%、73.3%。单项指标NLR的敏感性最高,HE4的特异性最高,联合指标的特异性和敏感性都很高。结论:术前血清CA125、HE4和NLR联合检测具有较高的特异性和敏感性,联合检测可以互为补充,提高子宫内膜癌的诊断准确率,对子宫内膜癌的诊断具有指导意义。

Objective:To investigate the clinical value of serum carbohydrate antigen 125(CA125),human epididymis protein 4(HE4)and neutrophil-lymphocyte ratio(NLR)in the diagnosis of endometrial cancer.Methods:42 patients with endometrial cancer,50 patients with endometrial benign disease and 50 healthy people were selected.Neutrophil and lymphocyte counts in peripheral blood were determined by SYSMEX XN550 automatic hematology analyzer,and NLR was calculated.The levels of preoperative serum CA125 and HE4 were determined by Maglumi4000 automatic chemiluminescence analyzer.ROC curve was used to analyse role of CA125,HE4,NLR and the combination of the three in the diagnosis of endometrial cancer.Results:Peripheral blood NLR was increased gradually in the healthy group,benign group and endometrial cancer group(P<0.05).The expression of serum HE4 in the endometrial cancer group was significantly higher than that in the benign group and the healthy group(P<0.05),but there was no significant difference between the benign group and the healthy group(P>0.05).There was no significant difference in serum CA125 expression in the three groups(P>0.05).The AUC of CA125,HE4,NLR and the three combined markers was 0.530,0.733,0.795,0.823,respectively.When their cut-off values were taken,the specificity was 70.8%,85.1%,61.7%,83.0%,respectively,and the sensitivity was 40.0%,63.3%,86.7%,73.3%.The sensitivity of NLR was higher than CA125,HE4,but the specificity of HE4 was most highest.The combined markers had high specificity and sensitivity.Conclusion:The combined detection of preoperative serum CA125,HE4 and NLR has high specificity and sensitivity,which can guide the diagnosis of endometrial cancer,improve the accuracy of clinical diagnosis of endometrial cancer.