HE4、CA125及ROMA对卵巢恶性肿瘤的预测价值

The predictive value of HE4,CA125 and ROMA in the diagnosis of ovarian malignancy

目的:探讨血清人附睾蛋白4(human epididymalprotein4,HE4)与糖链抗原125(carbohydrate antigen 125,CA125)联合运用卵巢恶性肿瘤风险模型(risk of ovarianmalignancy algorithm,ROMA)检测对卵巢恶性肿瘤的预测价值。方法:收集南京医科大学第一附属医院370例妇科良恶性肿瘤患者,采用电化学发光法检测其血清HE4及CA125水平,并对其中194例盆腔包块患者运用ROMA计算风险预测概率(predicted probability,PP)值。比较3种指标诊断卵巢恶性肿瘤的灵敏度、特异度、阳性预测值、阴性预测值并绘制受试者工作曲线(receiver operating characteristic curve,ROC)。结果:卵巢恶性肿瘤组血清HE4水平显著高于其余各类妇科良恶性肿瘤组(P <0.05);卵巢恶性肿瘤组血清CA125水平显著高于除卵巢交界性肿瘤组及子宫腺肌症组外的其余各组(P <0.05)。上皮性卵巢癌(epithelial ovarian cancer,EOC)患者血清中HE4水平显著高于非EOC组(P <0.05);而CA125水平在两组之间无显著性差异(P <0.05)。腹水阳性的EOC患者血清HE4水平、CA125水平均显著高于腹水阴性者(P=0.001,P <0.001)。D-二聚体升高的EOC患者血清HE4水平显著高于D-二聚体正常患者(P=0.038)。CA125的灵敏度显著高于HE4(P=0.031),HE4的特异性及阳性预测值显著高于CA125及ROMA。以卵巢交界性及良性肿瘤为参照,ROMA的ROC-AUC显著高于CA125(P=0.006)。结论:血清HE4水平在诊断卵巢恶性肿瘤方面显著较CA125具有更高的特异性,两者联合的ROMA指数较单一检测CA125具有更优的预测价值。

Objective:This study aims to evaluate the predictive value of serum HE4,CA125 and ROMA(Risk of Ovarian Malignancy Algorithm)in the diagnosis of ovarian malignancies. Methods:This research enrolled 370 patients with benign or malignant gynecological tumors treated in the First Affiliated Hospital of Nanjing Medical University. Serum levels of HE4 and CA125 were measured by electrochemiluminescence. The predicted probability of ovarian malignancy(PP)was calculated by ROMA method in 194 patients initially diagnosed as pelvic mass. The sensitivity,specificity,positive predictive value and negative predictive value of each indicators in diagnosing ovarian malignancy were calculated and the ROC curves were drawn. Results:The level of serum HE4 in ovarian malignancy group was significantly higher than that in other benign or malignant gynecological tumors groups(P < 0.05). The level of serum CA125 in ovarian malignancy group was significantly higher than that in other groups except ovarian borderline tumors group and uterine adenomyosis group(P < 0.05). The level of serum HE4 in patients with epithelial ovarian cancer(EOC)was significantly higher than that in patients without EOC(P < 0.05). The levels of serum HE4 and CA125 in EOC patients with positive ascites were significantly higher than those in patients with negative ascites(P=0.001,P < 0.001). The level of serum HE4 in EOC patients with abnormal D-dimer were significantly higher than those in patients with normal D-dimer(P=0.038). The sensitivity of CA125 was significantly higher than that of HE4(P=0.031). The positive predictive value of HE4 was significantly higher than that of ROMA or CA125(P < 0.05). The ROC-AUC of ROMA was higher than that of CA125(P=0.006). Conclusion:The specificity of serum HE4 was higher than that of CA125 in the diagnosis of ovarian malignancies. The combined ROMA index had better predictive value than detecting CA125 alone.