甲壳质酶蛋白40、糖类抗原125和人附睾蛋白4在子宫内膜癌病人血清中的表达及诊断价值

Expression and diagnostic value of serum human chitinase-3 like protein 1,carbohydrate antigen 125 and human epididymal protein 4 in patients with endometrial cancer

目的探讨甲壳质酶蛋白40(human chitinase-3 like protein 1,YKL-40)、糖类抗原125(carbohydrate antigen 125,CA125)及人附睾蛋白4(human epididymal protein 4,HE4)在子宫内膜癌病人血清中的表达特点及诊断价值。方法选取潍坊市人民医院2017年9月至2019年12月收治的子宫内膜癌病人51例为试验组,同期子宫良性病变(子宫内膜息肉、子宫肌瘤)病人40例为对照组。采用酶联免疫吸附测定(ELISA)、直接化学发光法检测YKL-40、CA125和HE4在血清中的表达,分析三者在子宫内膜癌病人血清中的诊断效能以及与临床病理因素的关系。结果试验组病人的术前血清YKL-40、CA125、HE4水平[(104.56±42.17)μg/L、(22.06±9.72)U/mL、(87.54±26.09)pmol/L]均显著高于对照组[(34.65±13.96)μg/L、(8.23±3.60)U/mL、(50.43±18.92)pmol/L]。试验组血清YKL-40表达与手术病理分期、病理类型有关,CA125表达与手术病理分期有关,HE4表达与肌层浸润深度、手术病理分期、淋巴结转移、脉管浸润有关。血清YKL-40与CA125、HE4均呈正相关(r=0.345,P=0.001;r=0.507,P<0.001)。血清YKL-40、CA125、HE4等三指标,对子宫内膜癌的诊断效能AUC(95%CI)分别为:0.882(0.800~0.967)、0.770(0.580~0.964)、0.813(0.691~0.936)。三指标联合应用效能最高,AUC(95%CI)为0.930(0.902~0.945)。结论YKL-40和HE4有望成为子宫内膜癌的肿瘤标志物,YKL-40、CA125、HE4联合检测在子宫内膜癌诊断中具有潜在价值。

Objective To investigate the expression and clinical significance of serum human chitinase-3 like protein 1(YKL-40),carbohydrate antigen 125(CA125)and human epididymal protein 4(HE4)in patients with endometrial cancer.Methods Fifty-one patients with endometrial cancer admitted to People's Hospital of Weifang from September 2017 to December 2019 were selected as the experimental group,and 40 patients with benign uterine lesions(endometrial polyps and uterine fibroids)during the same period were selected as the control group.Expressions of serum YKL-40,CA125 and HE4 were detected by enzyme-linked immunosorbent assay(ELISA)and direct chemiluminescence methods.The diagnostic efficacy of the three in the serum of patients with endometrial cancer and their relationship with clinicopathological factors were analyzed.Results The preoperative serum levels of YKL-40,CA125,and HE4 in the test group patients[(104.56±42.17)μg/L,(22.06±9.72)U/mL,(87.54±26.09)pmol/L]were significantly higher than those in the control group[(34.65±13.96)μg/L,(8.23±3.60)U/mL,(50.43±18.92)pmol/L].The expression of serum YKL-40 in the test group was related to the surgical pathological stage and pathological type.The expression of CA125 was related to surgical pathological stage.The expression of HE4 was related to the depth of myometrial invasion,surgical pathological stage,lymph node metastasis,and vascular infiltration.Serum YKL-40 was positively correlated with CA125 and HE4(r=0.345,P=0.001;r=0.507,P<0.001).The AUC(95%CI)of serum YKL-40,CA125 and HE4 were 0.882(0.800-0.967),0.770(0.580-0.964)and 0.813(0.691-0.936),respectively.The combined application of the three indexes had the highest efficiency,with AUC(95%CI)of 0.930(0.902-0.945).Conclusions YKL-40 and HE4 are expected to become endometrial cancer tumor markers.The combination of YKL-40,CA125,and HE 4 has potential value in the detection of endometrial cancer.