卵巢良性肿瘤合并慢性肾脏病患者人附睾蛋白4水平的临床分析

Clinical analysis of human epididymis protein 4 level in patients with benign ovarian tumors and chronic kidney disease

目的探讨人附睾蛋白4(HE4)在卵巢肿瘤中的临床价值,及其在卵巢良性肿瘤合并慢性肾脏病(CKD)与卵巢癌鉴别诊断中的意义,为卵巢肿瘤的诊断提供依据。方法选取2017年7月至2018年8月在台州市第一人民医院妇科就诊的53例卵巢癌患者,74例卵巢良性肿瘤患者,36例卵巢良性肿瘤合并CKD患者及43例健康体检妇女(对照组)为研究对象,采用电化学发光免疫法测定血清HE4、糖类抗原125(CA125)、癌胚抗原(CEA)、糖类抗原199(CA199)和糖类抗原724(CA724)水平。采用SPSS 17.0软件进行方差分析、Kruskal-Wallis H检验和Mann-Whitney U检验,采用受试者工作特征曲线(ROC曲线)分析生化指标在卵巢癌中的诊断价值。结果卵巢癌患者血清HE4、CA125、CEA、CA199和CA724水平显著高于卵巢良性肿瘤组、卵巢良性肿瘤合并CKD组和对照组,差异均有统计学意义(P<0.05)。HE4、CA125、CEA、CA199和CA724诊断卵巢癌的ROC曲线的曲线下面积(AUC)分别为0.839、0.803、0.703、0.743和0.669;两种或多种肿瘤标志物联合使用可获得更大的AUC,HE4+CA125联合检测的AUC为0.898,5项指标联合检测的AUC最高,为0.971。卵巢良性肿瘤合并CKD组的HE4水平明显高于卵巢良性肿瘤组,差异有统计学意义(P<0.05),HE4在卵巢良性肿瘤合并CKD患者与卵巢癌的鉴别诊断中的诊断价值偏低(AUC为0.667)。多项指标联合有助于卵巢良性肿瘤合并CKD患者与卵巢癌的鉴别诊断,5项指标联合检测的AUC最大(0.905)。结论 HE4和CA125或更多肿瘤标志物联合应用可提高卵巢癌诊断效能。HE4是CKD的潜在生物标志物,针对肾功能不全患者应用HE4进行卵巢癌诊断时应注意肿瘤性质的鉴别。

Objective To explore the clinical value of human epididymis protein 4(HE4)in ovarian tumors and the significance in differential diagnosis among benign ovarian tumors with chronic kidney disease(CKD)and ovarian cancer,and to provide the reference for the diagnosis of ovarian tumors.Methods From July of 2017 to August of 2018,53 cases of ovarian cancer,74 cases of benign ovarian tumors,36 cases of benign ovarian tumors and CKD,and 43 cases of healthy women(control group)who attended to gynecology department of Taizhou First People’s Hospital served as the subjects.The serum levels of HE4,carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),and carbohydrate antigen 724(CA724)were detected by electrochemiluminescent immunoassay.The variance analysis,Kruskal-Wallis H test and Mann-Whitney U test were used to analyze the data,and receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic value of HE4 and other indicators in ovarian cancer.The used software was SPSS 17.0.Results The serum levels of HE4,CA125,CEA,CA199,CA724 in patients with ovarian cancer were significantly higher than those in benign ovarian tumors group,benign ovarian tumors and CKD group and control group(P<0.05).The areas under the receiver operating characteristic curve(AUC)of HE4,CA125,CEA,CA199,and CA724 was 0.839,0.803,0.703,0.743,and 0.669,respectively.The combined use of two or more tumor markers may have a greater AUC;the combined use of HE4 and CA125 had an AUC of 0.898,and the combined use of five indicators had the greatest AUC(0.971).The HE4 level of benign ovarian tumors with CKD group was significantly higher than that of benign ovarian tumors group,P<0.05.The differential diagnosis value of HE4 in between benign ovarian tumors with CKD group and ovarian cancer group was lower(AUC=0.667).The combined use of multiple indicators was helpful to the differential diagnosis of benign ovarian tumors with CKD and ovarian cancer.The combined use of five indicators had the greatest AUC(0.905).Conclusion The combination of HE4 and CA125 or more tumor markers may improve the diagnostic efficacy of ovarian cancer.HE4 is a potential biomarker of CKD,and clinicians should pay attention to the differentiation of the tumor types when HE4 was used to diagnose ovarian cancer in patients with renal insufficiency.