国际妇产科学杂志

国际妇产科学杂志 ›› 2016, Vol. 43 ›› Issue (2): 165-168.

• 论著 • 上一篇    下一篇

人附睾蛋白4在子宫内膜非典型增生患者中筛查子宫内膜癌的临床价值

丁巍，李瑛，朱颖军   

  1. 300100 天津市中心妇产科医院普妇科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2016-04-15 发布日期:2016-04-15

Clinical Value of Human Epididymal Protein 4 in the Diagnosis of Endometrial Carcinoma in Atypical Endometrial Hyperplasia Patients

DING Wei，LI Ying，ZHU Ying-jun   

  1. Department of Gynecology，Tianjin Central Hospital of Gynecology Obstetrics，Tianjin 300100，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2016-04-15 Online:2016-04-15

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摘要： 目的：探讨人附睾蛋白4（human epididymis protein 4，HE4）检测在诊断性刮宫（诊刮）病理为子宫内膜非典型增生（atypical endometrial hyperplasia，AEH）患者中筛查子宫内膜癌（endometrial carcinoma，EC）的临床价值。方法：选取2011年1月—2014年12月在天津市中心妇产科医院诊刮病理为AEH进而行手术治疗的患者，术前采用电化学发光免疫分析法检测患者血清HE4、CA125和CA199水平，根据术后病理分为EC组和AEH组，分析2组患者肿瘤标记物的水平差异。制作受试者工作特征曲线（ROC），以曲线下面积（AUC）反映肿瘤标记物的诊断价值。结果：入选的118例诊刮病理为AEH的患者中，31例术后被诊断为EC（EC组），其血清HE4、CA125和CA199水平分别为73.4 pmol/L、31.4 kU/L和23.3 kU/L；87例术后诊断仍为AEH（AEH组），上述3种肿瘤标记物的水平分别为44.3 pmol/L、17.0 kU/L和19.0 kU/L；EC组HE4和CA125水平高于AEH组，差异有统计学意义（P＜0.05），而CA199水平差异无统计学意义（P＞0.05）。EC组以AEH组为参照时，HE4和CA125单独检测的AUC分别为0.785和0.706，两者联合检测的AUC为0.867，敏感度为76.6%。结论：EC患者血清HE4和CA125水平明显高于AEH患者，两者联合检测有助于筛查出诊刮病理为AEH人群中漏诊的EC患者。

关键词: 子宫内膜增生, 子宫内膜肿瘤, 附睾分泌蛋白质类, CA-125抗原, 肿瘤标记, 生物学

Abstract: Objective：To explore the clinical value of HE4 detection in the screening of endometrial carcinoma (EC) in atypical endometrial hyperplasia (AEH) patients diagnosed with curettage pathology. Methods：Between January 2011 and December 2014, the blood specimens were collected from the patients subjected to total hysterectomy with a preoperative biopsy diagnosis of AEH in Tianjin Central Hospital of Gynecology Obstetrics. Serum levels of HE4, CA125 and CA199 were detected by the electro-chemiluminescent immunoassay. According to the postoperative pathology, patients were divided into EC group and AEH group, and the differences of the tumor markers in the two groups were analyzed. Evaluate the diagnosis accuracy of the tumor markers by the area under the curve of receiver operating characteristic (ROC-AUC). Results：31 cases were diagnosed with postoperative EC in all the 118 preoperative atypical endometrial hyperplasia patients. Their serum level of HE4, CA125 and CA199 were 73.4 pmol/L, 31.4 kU/L and 23.3 kU/L. 87 were still AEH after the operation, the serum level of above tumor marker were 44.3 pmol/L, 17.0 kU/L and 19.0 kU/L. The median levels of HE4, CA125 in EC group were significantly higher than those in AEH group, the difference was statistically significant (P＜0.05), while the CA199 level in the two groups was not statistically different (P＞0.05). The ROC-AUC of HE4 and CA125 were 0.785 and 0.706 respectively. The AUC and sensitivity of joint detection were 0.867 and 76.6%. Conclusions：Serum HE4 and CA125 levels in EC group were significantly higher than those in AEH group. Combined detection of HE4 and CA125 is helpful to discriminate EC in patients with a preoperative diagnosis of AEH.

Key words: Endometrial hyperplasia, Endometrial neoplasms, Epididymal secretory proteins, CA-125 antigen, Tumor markers, biological