血清人附睾蛋白4、糖类抗原125辅助增强CT预测子宫内膜腺癌淋巴结转移的价值研究

The Diagnostic Value of Serum HE4 and CA_(125) Together with Enhanced CT in the Evaluation of Lymph Node Metastasis of Endometrial Adenocarcinoma

目的:分析人附睾蛋白4(HE4)、糖类抗原125(CA_(125))与子宫内膜腺癌淋巴结转移的关系,评价HE4、CA_(125)辅助增强CT预测子宫内膜腺癌淋巴结转移的诊断价值。方法:选择2017年1月至2020年12月因子宫内膜腺癌手术的326例患者为研究组,98例正常人群为对照组,进行回顾性分析,比较HE4、CA_(125)辅助增强CT预测淋巴结转移的诊断效能。结果:研究组与对照组比较、淋巴结阳性组与阴性组比较HE4、CA_(125)差异均有统计学意义(P<0.001);绝经前、后组诊断淋巴结转移的HE4的曲线下面积分别为0.73(P=0.001)和0.578(P=0.164),CA_(125)曲线下面积分别为0.81(P<0.001)和0.671(P=0.002);绝经前组HE4≥52.95 pmol/L,CA_(125)≥69.45 U/ml;绝经组HE4≥69.15 pmol/L,CA_(125)≥21.45 U/ml是预测淋巴结转移的临界值。绝经前组:增强CT单独扫描淋巴结转移的特异度为93%,HE4和CA_(125)的敏感度为86%和59%;并联实验的敏感度100%,阴性预测值100%;串联实验的特异度100%,阳性预测值100%。绝经组:增强CT单独扫描淋巴结转移的特异度94%,HE4和CA_(125)的敏感度为65%和74%;并联实验的敏感度97%,阴性预测值99%;串联实验的特异度97%,阳性预测值45%。结论:增强CT联合血清HE4及CA_(125)检查能提高预测子宫内膜腺癌淋巴结转移的诊断效能。

Objective:To analyze the functional effects of HE4 and CA_(125) on lymph node metastasis of endometrialadenocarcinoma,and to evaluate the diagnostic value of HE4 and CA_(125) together with enhanced CT in predicting lymph node metastasis.Methods:From January 2017 to December 2020,326 patients with endometrial adenocarcinoma surgery(experimental group)and 98 normal people(control group)were selected.A retrospective analysis was performed to compare the diagnostic efficacy of lymph node metastasis predicted by HE4 and CA_(125) together with enhanced CT.Results:We found statistically significant differences in HE4 and CA_(125) between the experimental group and the control group,and between the lymph node positive group and the negative group(P<0.001).The area under the HE4 curve was 0.73(P=0.001)and 0.578(P=0.164),respectively,and the area under the CA_(125) curve was 0.81(P<0.001)and 0.671(P=0.002),respectively,in the premenopausal and postmenopausal groups for the diagnosis of lymph node metastasis.Regarding prediction of lymph node metastasis,the cut off concentrations of HE4 and CA_(125) were 52.95 pmol/l and 69.45 U/ml,respectively,in the premenopausal group,and 69.15 pmol/l and 21.45 U/ml,respectively,in the postmenopausal group.In the premenopausal group,the specificity of enhanced CT alone for lymph node metastasis was 93%,and the sensitivity of HE4 and CA_(125) was 86% and 59%.The sensitivity and negative predictive value of parallel experimental were 100% and 100%.The specificity and positive predictive value of tandem experimental were 100%.In the menopausal group,the specificity of enhanced CT alone for lymph node metastasis was 94%,and the sensitivity of HE4 and CA_(125) was 65% and 74%.The sensitivity and negative predictive value of parallel experimental were 97% and 99%.The specificity and positive predictive value of the tandem experimental were 97% and 45%.Conclusions:Enhanced CT in combination with serum HE4 and CA_(125) improves the diagnostic efficacy in predicting lymph node metastasis.