血清鳞状细胞癌抗原、组织蛋白酶D和糖类抗原125检测对宫颈鳞癌诊断及预测转移的应用价值

Value of serum SCCAg, Cath-D and CA125 in diagnosis and metastasis-prediction of cervical squamous carcinoma

摘要:

目的  探讨血清鳞状细胞癌抗原（SCCAg）、组织蛋白酶D（Cath-D）、糖类抗原125（CA125）联合检测对宫颈鳞癌诊断及预测转移的临床应用价值。方法  酶联免疫吸附法（ELISA）检测血清中SCCAg和Cath-
D水平，全自动化学发光免疫分析法检测CA125。收集2009年1月30日-2012年4月1日宫颈鳞癌患者（ⅠA2～ⅡA期）60例为研究组；宫颈上皮内瘤变组（CIN组）60例为对照组1；慢性宫颈炎组60例为对照组2。研究组在术前检测血清SCCAg、Cath-D、CA125水平，分析血清SCCAg、Cath-D、CA125水平与宫颈鳞癌、临床病理特征、转移及复发之间的相关性。结果  宫颈鳞癌组手术前的SCCAg、Cath-D和CA125水平分别为（1.41±0.26）ng/ml、（19.14±1.52）ng/L和（17.42±0.90）u/ml，明显高于CIN组和慢性宫颈炎组，差异有统计学意义（P =
0.003、0.005、0.000、0.000、0.000和0.000）；SCCAg、Cath-D水平与宫颈鳞癌临床分期、肿瘤体积、分化程度、间质浸润深度、脉管癌栓、宫旁转移、盆腔淋巴结转移有不同程度相关，差异有统计学意义（P <0.05），CA125水平变化与宫颈癌间质浸润深度密切相关，差异有统计学意义（P =0.007）。应用工作特征曲线（ROC）分析SCCAg、Cath-D和CA125诊断宫颈鳞癌的临界值分别为1.03 ng/ml、13.58 ng/L和8.16 u/ml，预测转移临界值分别为3.21 ng/ml、21.20 ng/L和12.45 u/ml，曲线下面积（AUC）分别为0.954、0.905和0.718。结论  血清SCCAg和Cath-D水平对宫颈鳞癌的诊断、临床分期、预判复发具有很高的临床诊断价值；SCCAg、Cath-D和CA125 3项指标联合使用，可明显提高预测宫颈鳞癌转移的临床价值。

Abstract:

Objective To evaluate the clinical application value of detecting the serum levels of squamous cell carcinoma antigen (SCCAg), cathepsin-D (Cath-D) and carbohydrate antigen (CA125) in the diagnosis and prediction of the metastasis of squamous carcinoma of the cervix (SCC). Methods Serum levels of SCCAg and Cath-D were tested by ELISA, and CA125 level was detected by chemiluminescent immunoassay. All the cases were collected from Jan. 30, 2009 to Apr. 1, 2012. The experiment group consisted of 60 cases with stageⅠA2-ⅡA SCC. The control group was divided into two subgroups: cervical intraepithelial neoplasia (CIN) group and chronic cervicitis group with 60 cases in each group. Serum levels of SCCAg, Cath-D and CA125 in the experimental group were detected before operation. Then the relationships of serum SCCAg, Cath-D and CA125 levels with pathological features, metastasis and relapse of SCC were analyzed. Results The preoperative serum levels of SCCAg, Cath-D and CA125 in the experiment group were (1.41 ± 0.26) ng/ml, (19.14 ± 1.52) ng/L and (17.42 ± 0.90) u/ml respectively, which were significantly higher than those in the two control groups (P = 0.003, 0.005, 0.000, 0.000, 0.000 and 0.000). The serum levels of SCCAg and Cath-D had different degrees of correlations with clinical stage, gross tumor volume, tumor cell differentiation, depth of interstitial infiltration, vascular tumor embolus, para-uterine metastasis, and pelvic lymph node metastasis of SCC, and the differences were significant (P < 0.05). The change of CA125 level was only related to the depth of interstitial invasion of cervical cancer, and the difference was significant (P = 0.007). Based on the ROC analysis, the critical values of SCCAg, Cath-D and CA125 for diagnosis of SCC were 1.03 ng/ml, 13.58 ng/L and 8.16 u/ml; and the critical values for predicting metastasis were 3.21 ng/ml, 21.20 ng/L and 12.45 u/ml; and the area under the ROC curve (AUC) was 0.954, 0.905 and 0.718, respectively. Conclusions Detection of SCCAg and Cath-D in serum has high clinical value for diagnosing and staging SCC as well as predicting its recurrence. The combination of SCCAg, Cath-D and C A125 could improve the accuracy of predicting metastasis of SCC.