常用肿瘤标志物在上皮性卵巢癌诊断中的临床价值

Clinical value of commonly used tumor markers in epithelial ovarian cancer diagnosis

摘要:

目的研究常用肿瘤标志物糖链抗原（CA125 和CA199）、人附睾蛋白4（HE4）、乳酸脱氢酶（LDH）单项及联合检测在上皮性卵巢癌诊断中的临床价值。方法用化学发光微粒子免疫检测法和酶速率法检测220例上皮性卵巢癌患者、78 例卵巢上皮性交界性肿瘤患者、120 例卵巢成熟性畸胎瘤患者及162 例卵巢子宫内膜异位症患者血清中肿瘤标志物浓度。结果①上皮性卵巢癌组的CA125、CA199、HE4及LDH高于其他3组（p <0.008）；②4 种肿瘤标志物中HE4 诊断上皮性卵巢癌的敏感性为73.18％，特异性为98.89％，约登指数（Youdenindex）为72.07％，受试者工作特征曲线（ROC 曲线）下面积为0.952，综合其他评价指标，可得出HE4 的诊断能力最好；③联合检测组中CA125、CA199、HE4 及LDH 四项联合检测诊断上皮性卵巢癌的敏感性为97.73％，特异性为25.00％，ROC曲线下面积为0.973，其诊断价值最高。结论CA125、CA199、HE4 及LDH 4项联合检测是诊断上皮性卵巢癌比较理想的肿瘤标志物组合，对卵巢良恶性肿瘤的鉴别诊断具有重要临床价值。

关键词:肿瘤标志物;联合检测;上皮性卵巢癌;诊断

Abstract:

To evaluate the clinical value of CA125, CA199, HE4 and LDH single and combined detection in epithelial ovarian cancer diagnosis. Methods Chemiluminescent microparticle immunoassay and enzyme rate assay were used to detect the serum levels of tumor markers, 220 epithelial ovarian cancer patients, 78 epithelial ovarian borderline tumor patients, 120 ovarian mature teratoma patients and 162 ovarian endometriosis patients were detected. Results The levels of CA125, CA199, HE4 and LDH in epithelial ovarian cancer group were significantly higher than other three groups (p < 0.008). The sensitivity of HE4 in the diagnosis of epithelial ovarian cancer was 73.18%, the specificity was 98.89%, the Youden index was 72.07% and the area under the ROC curve was 0.952. HE4 was the best among four tumor markers when considered all evaluation indexes. The sensitivity of combined detection of CA125, CA199, HE4 and LDH was 97.73%, the specificity was 25% and the area under the ROC curve was 0.973. Combined detection of four tumor markers showed the highest diagnostic value. Conclusions The combined detection of CA125, CA199, HE4 and LDH is the ideal combination of tumor markers on epithelial ovarian cancer diagnosis, and has certain clinical value in benign and malignant ovarian tumors diagnosis.

Key words:tumor marker; combined detection; epithelial ovarian cancer; diagnosis