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目的:探讨上皮细胞黏附分子(Ep CAM)和CA125水平变化与子宫内膜样腺癌(EAC)及子宫癌前病变发生、发展的关系和在诊断、监测EAC及子宫癌前病变方面的临床价值。方法:抽取26份EAC患者术前血清标本及其中17份术后血清标本;抽取6例子宫内膜不典型增生(EIN)患者及17例对照组患者手术前后血清标本(增生性子宫内膜5例、分泌性子宫内膜6例、萎缩性子宫内膜6例)。采用ELISA测定Ep CAM及CA125在上述血清标本中的表达水平。结果:术前,Ep CAM和CA125在对照组、EIN组及EAC组血清中的表达水平递次增加(P<0.05);术后,3组血清Ep CAM和CA125水平较术前均有所降低。在EAC组及对照组中,无绝经史者术前血清Ep CAM水平显著低于有绝经史者(P<0.05),CA125水平则相反(P<0.05)。在诊断EAC及EIN的敏感度、特异度、准确度和阳性预测值方面,血清Ep CAM水平均高于血清CA125水平,二者联合检测提高了诊断的敏感度和准确度;在EAC组及EIN组中,有绝经史者血清CA125诊断的敏感度高于血清Ep CAM,但无绝经史者则相反,二者联合检测提高了诊断敏感度。结论:血清Ep CAM和CA125水平可能与子宫内膜癌的发生、发展有关;二者联合检测可能成为诊断EAC更便捷、有效、互补的方法;分泌性子宫内膜患者的血清Ep CAM水平明显低于其他患者,提示其可能对判定非EAC状态及监测孕激素治疗效果具有指导意义。
OBJECTIVE: To investigate the clinical value of the changes of epithelial cell adhesion molecules (Ep CAM) and CA125 levels in the pathogenesis and development of endometrial adenocarcinoma (EAC) and uterine precancerous lesions and in the diagnosis and monitoring of EAC and uterine precancerous lesions . Methods: Twenty-six preoperative serum samples and 17 postoperative serum samples were collected from the EAC patients. Serum samples (proliferative endometrial 5 Cases, secretory endometrium in 6 cases, atrophic endometrium in 6 cases). The expression levels of Ep CAM and CA125 in the serum samples were determined by ELISA. Results: Before operation, the levels of Ep CAM and CA125 in the serum of the control group, EIN group and EAC group were increased (P <0.05), and the levels of Ep CAM and CA125 in the three groups were lower than those before operation . In the EAC group and control group, the serum levels of Ep CAM before and after menopause were significantly lower than those with menopausal history (P <0.05) and CA125 levels (P <0.05). In the diagnosis of EAC and EIN sensitivity, specificity, accuracy and positive predictive value, serum Ep CAM levels were higher than the level of serum CA125, the combination of the two to improve the diagnostic sensitivity and accuracy; in the EAC group and EIN In the group, the sensitivity of diagnosis of serum CA125 in men with history of menopause was higher than that of serum Ep CAM, but the history of men without history of menopause was the opposite. The combined detection of the two improved the diagnostic sensitivity. Conclusions: The levels of serum Ep CAM and CA125 may be related to the occurrence and development of endometrial carcinoma. The combined detection of them may be a convenient, effective and complementary method for the diagnosis of EAC. The level of serum Ep CAM in secretory endometrium is significantly lower In other patients, suggesting that it may guide the determination of non-EAC status and monitoring the effect of progestin therapy.