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目的探讨血清人附睾分泌蛋白4(HE4)联合糖链多肽抗原125(CA125)对卵巢癌患者的早期诊断和预后随诊的价值。方法将天津市中心妇产科医院2011年11月至2012年5月收治的68例诊断为卵巢癌的患者纳入卵巢癌组,将同期收入院的72例诊断为妇科良性肿块的患者(其中有卵巢巧克力囊肿37例,卵巢良性肿瘤27例,盆腔脓肿8例)纳入良性肿块组,因体检来院的健康妇女40例纳入对照组。采用酶联免疫吸附法(ELISA)和电化学发光法测定3组妇女的血HE4和CA125水平,结合患者的月经情况进行统计和分析。结果 (1)未绝经组和已绝经组中,卵巢癌患者的HE4和CA125水平均高于良性肿块组和健康对照组,差异均有统计学意义(P<0.05,P<0.01);未绝经组的HE4水平检测对卵巢癌的预测特异度和阳性预测值分别为96.6%和92.8%,已绝经组为90.7%和93.4%,两组均明显高于CA125的检测特异度和阳性预测值(未绝经组为69.8%和59.1%,已绝经组为65.6%和62.7%)。(2)利用卵巢癌风险模型(ROMA模型)对卵巢癌组进行评估,ROMA模型的灵敏度为87.3%,特异度为77.8%;(3)卵巢癌患者术后1个月复查HE4和CA125水平,较术前明显下降,差异有统计学意义(P<0.05)。结论 HE4与CA125早期诊断卵巢癌的灵敏度相当;HE4的特异性高于CA125,HE4对于卵巢癌的预后评估具有一定价值;HE4联合CA125对卵巢癌患者的早期诊断和预后的评估有重要的临床价值,值得在临床推广应用。
Objective To investigate the value of serum human epididymal secretion protein 4 (HE4) combined with carbohydrate antigen 125 (CA125) in the early diagnosis and prognosis of patients with ovarian cancer. Methods Sixty-eight ovarian cancer patients admitted from November 2011 to May 2012 in Tianjin Central Obstetrics and Gynecology Hospital were enrolled in the ovarian cancer group. 72 patients diagnosed as benign gynecologic tumors in the same period were enrolled 37 cases of ovarian chocolate cysts, benign ovarian tumors in 27 cases, 8 cases of pelvic abscess) into the benign mass group, due to physical examination to hospital 40 healthy women into the control group. The blood levels of HE4 and CA125 in three groups of women were measured by enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence (PLG), and the patients’ menstrual conditions were statistically analyzed. Results (1) In non-menopausal and postmenopausal women, the levels of HE4 and CA125 in ovarian cancer patients were significantly higher than those in benign tumors and healthy controls (P <0.05, P <0.01) The predictive specificity and positive predictive value of HE4 level in ovarian cancer group were 96.6% and 92.8%, respectively, and 90.7% and 93.4% in menopause group, respectively, which were significantly higher than those of CA125 and positive predictive value 69.8% and 59.1% in the non-menopausal group and 65.6% and 62.7% in the menopause group). (2) The ovarian cancer group was evaluated by the ovarian cancer risk model (ROMA model). The sensitivity and specificity of the ROMA model were 87.3% and 77.8% respectively. (3) The ovarian cancer patients were examined HE4 and CA125 levels one month after the operation, Compared with preoperative significantly decreased, the difference was statistically significant (P <0.05). Conclusion The sensitivity of HE4 and CA125 in the early diagnosis of ovarian cancer is comparable. The specificity of HE4 is higher than that of CA125. HE4 is of certain value in the prognosis evaluation of ovarian cancer. HE4 combined with CA125 has important clinical value in early diagnosis and prognosis evaluation of patients with ovarian cancer , It is worth to promote clinical application.