多种血清肿瘤标志物联合应用在卵巢癌诊断中的临床价值

Application of multiple serum tumor markers detection in the diagnosis of ovarian cancer

目的探讨血清人附睾蛋白4(HE4)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、糖类抗原15-3(CA15-3)、癌胚抗原(CEA)单个或联合检测在卵巢癌诊断中的临床价值。方法选取该院2020年1-12月卵巢癌患者89例(恶性组)、卵巢良性肿瘤患者133例(良性组),以及体检的健康女性140例(对照组)为研究对象。采用电化学发光免疫法测定HE4、CA125水平,采用流式荧光发光法测定CA19-9、CA15-3和CEA水平。统计分析单项和联合检测的灵敏度、特异度,并作诊断效能评价。结果恶性组患者血清HE4、CA125、CA19-9、CA15-3和CEA水平明显高于良性组和对照组(P<0.001)。HE4、CA125、CA19-9、CA15-3和CEA单独检测诊断卵巢癌的灵敏度分别为69.66%、63.90%、55.06%、43.82%和58.43%,特异度分别为90.90%、71.60%、79.70%、84.20%、63.20%(P<0.001)。联合两种或多种肿瘤标志物检测比单一肿瘤标志物灵敏度更高,HE4+CA125联合检测,其灵敏度为70.79%,特异度为89.47%。HE4+CA125联合CA19-9、CA15-3和CEA检测时,灵敏度为87.64%,特异度为84.96%。单项肿瘤标志物检测的受试者工作特征曲线下面积(AUC)最高为HE4(0.852),最低为CEA(0.628);联合检测时,HE4+CA125+CA19-9+CA153的AUC最高(0.919),HE4+CA125的AUC最低(0.870)。结论多种肿瘤标志物联合检测可提高卵巢癌患者诊断效率,在卵巢良、恶性肿瘤的鉴别诊断中也具有重要价值。

Objective To investigate the diagnostic value of the single and combined use of serum human epithelial protein 4(HE4),crbohydrate antigen 125(CA125),crbohydrate antigen 19-9(CA19-9),crbohydrate antigen 15-3(CA15-3),and carcinoembryonic antigen(CEA)in ovarian cancer.Methods 89 patients with ovarian cancer(malignant group),133 patients with benign ovarian tumors(benign group),and 140 healthy women(control group)were selected as research objects in the hospital from January to December 2020.HE4 and CA125 levels were measured by electrochemiluminescence immunoassay,while CA19-9,CA15-3 and CEA levels were measured by flow-through fluorescence luminescence.The diagnostic sensitivity and specificity of the single and combined tests were statistically analyzed,and the diagnostic efficacy was evaluated.Results When compared with the benign and control groups,the serum HE4,CA125,CA19-9,CA15-3 and CEA levels of the malignant group were significantly higher(P<0.001).The diagnostic sensitivity of HE4,CA125,CA19-9,CA15-3 and CEA in diagnosis of ovarian cancer were 69.66%,63.90%,55.06%,43.82%and 58.43%,respectively.However,the specificity were 90.90%,71.60%,79.70%,84.20%,and 63.20%,respectively(P<0.001).The combined use of two or more tumor markers was more sensitive than a single tumor marker,and the diagnostic sensitivity of HE4+CA125 was 70.79%and the specificity was 89.47%.When HE4+CA125 was combined with CA19-9,CA15-3 and CEA,the sensitivity was 87.64%and the specificity was 84.96%.The highest area under working characteristic curve(AUC)of single serum HE4 for diagnosis of ovarian cancer was 0.852,the lowest AUC of CEA was 0.628.The AUC for combined assays was highest for HE4+CA125+CA19-9+CA153(0.919)and lowest for HE4+CA125(0.870).Conclusion The combination of multiple tumor markers could improve the diagnostic accuracy of ovarian cancer.It also can be regarded as an effective method for differential diagnosis between benign and malignant ovarian tumors.