血清HE4、PKM2、sFLT1水平结合3D-TVS血流动力学指数对子宫内膜癌的诊断价值

Diagnostic Value of Serum HE4,PKM2 and sFLT1 Levels Combined with 3D-TVS Hemodynamic Index for Endometrial Cancer

目的:探究血清人附睾蛋白4(HE4)、丙酮酸激酶M2型(PKM2)、可溶性血管内皮生长因子受体-1(sFLT1)水平结合经阴道三维超声(3D-TVS)血流动力学参数对子宫内膜癌的诊断价值。方法:回顾性分析2019年1月-2020年12月在佳木斯市妇幼保健院就诊的172例子宫内膜病变患者的临床资料,根据病理诊断结果,将其分为子宫内膜癌组(n=93)和良性疾病组(n=79)。比较两组HE4、PKM2、sFLT1、3D-TVS血流动力学参数[血流指数(FI)、血管形成指数(VI)、血管形成-血流指数(VFI)]水平,并采用受试者工作特征曲线(ROC)分析这些指标单独及联合检测对子宫内膜癌的诊断价值。结果:子宫内膜癌组HE4、PKM2水平均高于良性疾病组,sFLT1水平低于良性疾病组,差异均有统计学意义(P<0.05)。子宫内膜癌组VI、FI、VFI均高于良性疾病组,差异均有统计学意义(P<0.05)。ROC曲线分析显示,HE4、PKM2、sFLT1、3D-TVS以及各指标联合对子宫内膜癌的诊断价值的AUC分别为0.755、0.816、0.798、0.927、0.999,且各项联合的AUC显著高于HE4、PKM2、sFLT1、3D-TVS的AUC(Z=6.419、5.900、5.741、3.994,P<0.05)。根据最佳临界值,当HE4高于80.67 pmol/L时,其敏感度为50.5%,特异度为98.7%;当PKM2高于13.66 ng/mL时,其敏感度为91.4%,特异度为58.2%;当sFLT1低于74.24 pg/mL时,其敏感度为69.6%,特异度为80.6%;当3D-TVS高于18.41时,其敏感度为83.9%,特异度为82.3%;当联合预测因子高于11.54时,其敏感度为96.8%,特异度为100%。结论:血清HE4、PKM2在子宫内膜癌中水平均升高,sFLT1水平降低,且HE4、PKM2、sFLT1结合3D-TVS血流动力学参数对子宫内膜癌的诊断价值较高。

Objective:To investigate the diagnostic value of serum human epididymal protein 4 (HE4),pyruvate kinase type M2 (PKM2),soluble vascular endothelial growth factor receptor-1 (sFLT1) levels combined with three-dimensional transvaginal sonography (3D-TVS) hemodynamic parameters in the diagnosis of endometrial cancer.Method:A retrospective analysis was performed on the clinical data of 172 patients with endometrial lesions treated in Jiamusi Maternal and Child Health Care Hospital from January 2019 to December 2020,according to the pathological diagnosis results,they were divided into endometrial cancer group (n=93) and benign disease group (n=79).The levels of HE4,PKM2,sFLT1 and 3D-TVS hemodynamic parameters[blood flow index (FI),angiogenesis index (VI),angiogenesis-blood flow index (VFI)]were compared between the two groups,receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of these indexes for endometrial cancer alone and in combination.Result:The levels of HE4 and PKM2 in endometrial cancer group were higher than those in benign disease group,while the level of sFLT1 was lower than that in benign disease group,the differences were statistically significant (P<0.05).The VI,FI and VFI of endometrial cancer group were higher than those of benign disease group,the differences were statistically significant (P<0.05).ROC curve analysis showed that the AUC of HE4,PKM2,sFLT1,3D-TVS and their combination in the diagnosis of endometrial cancer were 0.755,0.816,0.798,0.927 and 0.999,respectively,the AUC of all combinations was significantly higher than that of HE4,PKM2,sFLT1 and 3D-TVS (Z=6.419,5.900,5.741,3.994,P<0.05).According to the optimal critical value,when HE4 is higher than 80.67 pmol/L,the sensitivity is 50.5% and the specificity is 98.7%;when PKM2 was higher than 13.66 ng/mL,the sensitivity was 91.4% and the specificity was 58.2%;when sFLT1 was lower than 74.24 pg/mL,the sensitivity was 69.6% and the specificity was 80.6%;when 3D-TVS was higher than 18.41,its sensitivity was 83.9% and specificity was 82.3%;when the combined predictor was higher than 11.54,the sensitivity was 96.8% and the specificity was 100%.Conclusion:The levels of serum HE4 and PKM2 in endometrial cancer increased and the level of sFLT1 decreased,the combination of HE4,PKM2 and sFLT1 with 3D-TVS hemodynamic parameters has high diagnostic value for endometrial cancer.