血清糖类抗原199、甲壳质酶蛋白40与Ⅰ期低危型子宫内膜癌的关系及对术后淋巴结转移的预测价值研究

The relationship between serum carbohydrate antigen 199,chitinase protein 40 and stageⅠlow-risk endometrial carcinoma and the prediction of postoperative lymph node metastasis

目的分析血清糖类抗原199(CA199)、甲壳质酶蛋白40(YKL-40)与Ⅰ期低危型子宫内膜癌的关系及对术后淋巴结转移的预测价值。方法将2017年1月至2018年12月常州市妇幼保健院接诊的136例Ⅰ期低危型子宫内膜癌患者作为观察组,将同期的136例子宫内膜增生患者作为对照组。比较两组血清CA199、YKL-40的水平;分析观察组手术前后血清CA199、YKL-40水平变化情况并随访24个月,使用受试者工作特征(ROC)曲线下面积(AUC)评价血清CA199、YKL-40对患者术后淋巴结转移的预测效能。结果观察组血清CA199、YKL-40水平均高于对照组(P<0.05)。观察组术后血清CA199、YKL-40水平均较术前降低(P<0.05);血清CA199联合YKL-40诊断Ⅰ期低危型子宫内膜癌的灵敏度为88.24%,特异度为86.76%;经ROC曲线分析,血清CA199联合YKL-40预测Ⅰ期低危型子宫内膜癌患者术后淋巴结转移的AUC为0.912;经多因素Logistic回归分析,血清CA199≥52.48kU/L、YKL-40≥146.87μg/L均是Ⅰ期低危型子宫内膜癌患者术后淋巴结转移的独立预测因素(P<0.05)。结论血清CA199、YKL-40与Ⅰ期低危型子宫内膜癌的病情演变有关,两者联合预测术后淋巴结转移的效能较好,其对Ⅰ期低危型子宫内膜癌的诊疗和术后随访具有指导作用。

Objective To analyze the relationship between serum carbohydrate antigen 199(CA199),chitinase protein 40(YKL-40)and stageⅠlow-risk endometrial carcinoma,and the predictive value for postoperative lymph node metastasis.Methods 136 patients with stageⅠlow-risk endometrial cancer in Changzhou Maternal and Child Health Care Hospital from January 2017 to December 2018 were selected as the observation group,and another 136 patients with endometrial hyperplasia in the same period were selected as the control group.The serum CA199 and YKL-40 levels of the two groups were compared,and the changes of serum CA199 and YKL-40 levels before and after operation in the observation group were analyzed.The patients were followed up for 24 months,receiver operating characteristic(ROC)area under curve(AUC)was used to evaluate the predictive effecacy of serum CA199 and YKL-40 on postoperative lymph node metastasis.Results The levels of serum CA199 and YKL-40 in the observation group were higher than those in the control group(P<0.05).The levels of serum CA199 and YKL-40 in the observation group after operation were lower than those before operation(P<0.05).The sensitivity and specificity of serum CA199 combined with YKL-40 in the diagnosis of stageⅠlow-risk endometrial cancer were 88.24%and 86.76%.The ROC curve analysis showed that the AUC of CA199 combined with YKL-40 in predicting postoperative lymph node metastasis in stageⅠlow-risk endometrial carcinoma was 0.912.Multivariate Logistic regression analysis showed that serum CA199≥52.48 kU/L and YKL-40≥146.87μg/L were independent predictors of postoperative lymph node metastasis in patients with stageⅠlow-risk endometrial cancer(P<0.05).Conclusions Serum CA199 and YKL-40 are related to the progression of stageⅠlow-risk endometrial cancer,the combination of them can predict postoperative lymph node metastasis better,which has a guiding role in the diagnosis and treatment of the disease and postoperative follow-up.