血清细胞角蛋白19片段、α-烯醇化酶检测在子宫内膜癌诊断及病情严重程度评估中的价值

Value of serum cytokeratin 19 fragment andα-enolase detection in diagnosis and severity assessment of endometrial carcinoma

目的:探讨血清细胞角蛋白19片段(CYFRA21-1)、α-烯醇化酶(ENO1)检测对子宫内膜癌的诊断价值以及对患者病情严重程度的评估作用。方法:选择83例子宫内膜癌患者、95例良性子宫内膜疾病患者和100例健康女性作为研究对象。采用酶联免疫吸附法检测血清CYFRA21-1、ENO1水平,比较各组血清CYFRA21-1、ENO1水平差异。分析血清CYFRA21-1、ENO1水平与子宫内膜癌患者病理特征的关系。采用受试者工作特征(ROC)曲线分析血清CYFRA21-1、ENO1水平诊断子宫内膜癌的效能。结果:子宫内膜癌组血清CYFRA21-1、ENO1水平高于良性子宫内膜疾病组和对照组,良性子宫内膜疾病组血清CYFRA21-1、ENO1水平高于对照组(均P<0.05)。透明细胞癌患者血清CYFRA21-1、ENO1水平高于其他三种类型,鳞癌患者血清CYFRA21-1、ENO1水平高于腺癌和混合性癌(均P<0.05)。Ⅲ期和Ⅳ期患者血清CYFRA21-1、ENO1水平均高于Ⅰ期和Ⅱ期患者(均P<0.05);Ⅱ期患者血清CYFRA21-1、ENO1水平高于Ⅰ期患者(均P<0.05)。不同分化程度患者血清CYFRA21-1、ENO1水平两两比较均有统计学差异(均P<0.05),高分化患者血清CYFRA21-1、ENO1水平最高。肌层浸润≥1/2、发生淋巴结转移的患者血清CYFRA21-1、ENO1水平高于肌层浸润<1/2、未发生淋巴结转移的患者(P<0.05)。复发组和术后1年内死亡的子宫内膜癌患者血清CYFRA21-1、ENO1水平均高于未复发组和未死亡患者(均P<0.05)。血清CYFRA21-1诊断子宫内膜癌的AUC为0.939,以≥4.8 ng/ml作为诊断阈值,其敏感度、特异度和约登指数分别为95.18%、75.90%和71.08%;血清ENO1诊断子宫内膜癌的AUC为0.879,以≥482.5 pg/ml作为诊断阈值,其敏感度、特异度和约登指数分别为85.54%、76.92%和62.47%。结论:血清CYFRA21-1、ENO1水平提高与子宫内膜癌多种病理特征相关,术后复发和1年内死亡患者血清CYFRA21-1、ENO1水平增加尤为明显,通过检测这两个指标可辅助诊断子宫内膜癌并对病情进行评估。

Objective:To investigate the diagnostic value of serum cytokeratin 19 fragment(CYFRA21-1)and alpha-enolase(ENO1)detection in endometrial carcinoma and their roles in evaluating the severity of patients’condition.Methods:A total of 83 patients with endometrial carcinoma,95 patients with benign endometrial disease and 100 healthy women were selected as the subjects.The levels of serum CYFRA21-1 and ENO1 were detected by enzyme-linked immunosorbent assay,and the differences of serum CYFRA21-1 and ENO1 levels among the groups were compared.The relationship between serum CYFRA21-1,ENO1 levels and pathological characteristics of endometrial cancer patients was analyzed.ROC curve was used to analyze the efficacy of serum CYFRA21-1 and ENO1 levels in the diagnosis of endometrial carcinoma.Results:The levels of serum CYFRA21-1 and ENO1 in endometrial carcinoma group were significantly higher than those in benign endometrial disease group and control group,and the levels of serum CYFRA21-1 and ENO1 in benign endometrial disease group were higher than those in control group(all P<0.05).The levels of serum CYFRA21-1 and ENO1 in patients with clear cell carcinoma were higher than those of the other three types,and the levels of serum CYFRA21-1 and ENO1 in patients with squamous cell carcinoma were higher than those of adenocarcinoma and mixed carcinoma(all P<0.05).The levels of serum CYFRA21-1 and ENO1 in patients with stageⅢandⅣwere higher than those in patients with stageⅠandⅡ,and the levels of serum CYFRA21-1 and ENO1 in patients with stageⅡwere higher than those in patients with stageⅠ(all P<0.05).The levels of serum CYFRA21-1 and ENO1 in patients with different degrees of differentiation were different(all P<0.05),and the levels of serum CYFRA21-1 and ENO1 in patients with high differentiation were the highest.The serum CYFRA21-1 and ENO1 levels in patients with myometrial invasion≥1/2 and lymph node metastasis were higher than those in patients with myometrial invasion<1/2 and no lymph node metastasis(all P<0.05).The serum levels of CYFRA21-1 and ENO1 in the recurrent group and dead patients within one year were higher than those in the non-recurrent group and the non-dead patients,respectively(all P<0.05).The AUC of serum CYFRA21-1 in the diagnosis of endometrial carcinoma was 0.939,taking≥4.8 ng/ml as the diagnostic threshold,its sensitivity,specificity and Youden index were 95.18%,75.90%and 71.08%respectively.The AUC of serum ENO1 in the diagnosis of endometrial carcinoma was 0.879,taking≥482.5 pg/ml as the diagnostic threshold,its sensitivity,specificity and Youden index were 85.54%,76.92%and 62.47%respectively.Conclusion:The increase of serum CYFRA21-1 and ENO1 levels is related to a variety of pathological characteristics of endometrial carcinoma.The increase of serum CYFRA21-1 and ENO1 levels is particularly obvious in patients with postoperative recurrence and death within one year.The detection of these two indicators can assist in the diagnosis of endometrial carcinoma and the evaluation of the condition.