血清HE4、CYFRA211、CA199在诊断卵巢良、恶性肿瘤中的价值

doi:10.3760/cma.j.issn.1673422X.2015.09.005

摘要/Abstract

摘要： 目的探讨血清人附睾蛋白4（HE4）、细胞角蛋白19片段(CYFRA211)、糖类抗原199（CA199)对卵巢恶性肿瘤诊断的意义，评价其单独及联合检测在判断卵巢癌高风险中的价值。方法采用电化学发光免疫法(ECL)检测威海市妇幼保健院就诊的45例原发性卵巢癌、56例良性卵巢肿瘤患者及50例健康体检女性血清中HE4、CYFRA211、CA199水平，分析三者在卵巢癌诊断中的阳性率及符合率，比较3种指标对卵巢肿瘤的诊断价值。结果血清HE4在恶性肿瘤组与良性肿瘤组之间、恶性肿瘤组与对照组之间差异均有统计学意义（Z=-8.61，P＜0.001；Z=-8.39，P＜0.001）;CYFRA211在恶性肿瘤组与良性肿瘤组之间，恶性肿瘤组与对照组差异有统计学意义（Z=-8.60，P＜0.001；Z=-8.39，P＜0.001），HE4、CYRA211良性肿瘤组与对照组比较差异无统计学意义（Z=-1.31，P=0.189; Z=-1.29，P=0.191）;CA199在良性肿瘤组与对照组比较差异有统计学意义（Z=-8.79，P＜0.001），对于恶性肿瘤两者诊断的特异性和阳性预测值都很高（HE4为99.8%、99.7%, CYFRA211为99.0%、96.7%)，HE4、CYFRA211诊断的符合率也比较高，分别为93.4%、88.7%，但两者的敏感性比CA199低。CA199在卵巢良、恶性肿瘤中都会升高，只是升高的程度不同，但对卵巢癌诊断的特异性不是很高（85.8%），阳性预测值和诊断符合率也比较低（70.6%、84.1%），三者联合检测则可以提高卵巢癌诊断的敏感性（100%）及准确性（89.4%）。结论 HE4、CYFRA211只在恶性卵巢肿瘤中升高，主要用于卵巢癌的诊断；CA199在良、恶性卵巢肿瘤中都有升高，但升高的程度不同，可用于良、恶性肿瘤的诊断与鉴别，三者联合检测则可提高卵巢癌诊断的敏感性和准确率，对于卵巢癌的早期诊断与治疗监测有重要的意义。

关键词: 卵巢肿瘤/ 角蛋白质类/ 抗原, 肿瘤相关, 碳水化合物/ 人附睾蛋白4

Abstract: ObjectiveTo investigate the diagnosis significance of human epididymis （HE4）, cytokeratin19fragment （CYFRA211), carbohydrate antigen 199 (CA199) on the malignant ovarian tumor, and to evaluate the value of individual and combined detection in judging high risk ovarian cancer. MethodsThe serum HE4, CYFRA211, CA199 levels of 45 patients with primary ovarian cancer, 56 patients with benign ovarian tumor and 50 healthy checkup women in our hospital were detected by electrochemiluminescence immunoassay (ECL).The positive rates and coincidence rates of them were analyzed and the diagnostic value of them were compared.ResultsHE4 and CYFRA211 levels of ovarian cancer group were significantly higher compared with the benign tumor group and healthy control group and the differences were statistically significant (Z=-8.61，P＜0.001；Z=-8.39，P＜0.001; Z=-8.60，P＜0.001；Z=-8.39，P＜0.001)， however there is no difference between benign tumor group andcontrol group(Z=-1.31，P=0.189; Z=-1.29，P=0.191). The difference of CA199 between benign tumor group and control group was statistically significant (Z=-8.79，P＜0.001).For the malignant tumors， the specificity and positive predictive value of HE4 (99.8%, 99.7%), CYFRA211 (99.0%, 96.7%) were very high and the diagnostic accordance rates were relatively high (93.4%, 88.7%), but the sensibilities of them were lower compared with CA199.CA199 was increased both in benign and malignant ovarian tumors with different degrees， but the specificity was not very high (85.8%), and the positive predictive value and the diagnosis accordance rate were low (70.6%, 84.1%). The combined detection of HE4， CYFRA 211 and CA199 could improve the sensitivity and of the diagnosis of ovarian cancer (100%) and accuracy (89.4%).ConclusionsHE4 and CYFRA211 only increas in malignant ovarian tumors, and they are mainly used for the diagnosis of ovarian cancer; CA199 level is increased both in benign and malignant ovarian tumors, but the extent is different and it can be used for distinguishing and diagnosing of benign and malignant ovarian tumors. Combining the three indexes can improve the sensitivity and accuracy of the diagnosis of ovarian cancer, and has an important significance for the early diagnosis and treatment of ovarian cancer.

Key words: Ovarian neoplasms/ Keratins/Antigens, tumorassociated, carbohydrate/ human epididymis protein 4

冷丽丽, 谷梅华. 血清HE4、CYFRA211、CA199在诊断卵巢良、恶性肿瘤中的价值[J]. 国际肿瘤学杂志, 2015, 42(8): 657-.

LENG Li-Li, GU Mei-Hua. Value of serum HE4, CYFRA21-1, CA199 in the diagnosis of ovarian benign and malignant tumor[J]. Journal of International Oncology, 2015, 42(8): 657-.

参考文献

［1］ Oberaigner W, Minicozzi P, BielskaLasota M，et al. Survial for ovarian cancer in Europe: the acrosscountry did not shrink in the past decade［J］. Acta Oncol, 2012， 51(4):441453. ［2］ Moore RG, MacLanghIan S, Bast Rc Jr. Current state of biomarket development for clinical application in epithelial ovarian cancer ［J］. Gynecol Oncol, 20l0, 116(2):240245. ［3］ Havrilesky LJ, Whitehead CM, Rubatt JM,et al. Evaluation of biomarker panels for early stage ovarian cancer detection and monitoring for disease recurrence［J］. Gynecol Oncol, 2008， 110(3):374382. ［4］ Karolina P, Bjorg KJ, Karin S, et al. Evaluation of ovarian cancer biomarkers HE4 and CA125 in women presenting with a suspicious cystic ovarian mass［J］. J Gynecol Oncol, 2011， 22(4):244252. ［5］ Brechot JM, Chevret S, Nataf J, et al. Diagnostic and prognostic value of Cyfra 211 compared with other tumor markers in patients with nonsmall lung cancer:a prospective study of 116 patients［J］. Eur J Cancer, 1997, 33(3):385391. ［6］ Kawai M， Kano T， Kikkawa F, et al. Seven tumor markers in benign and malignant germ cell tumors of the ovary ［J］. Gynecol Oncol, 1992, 45(3):248253. ［7］ Fioretti P, Gadducci A, Ferdeghini M, et al. The concomitant determination of different serum tumor markers in epithelial ovarian cancer:relewance for monitoring the response to chemotherapy and followup of patients［J］. Gynecol Oncol, 1992, 44(2):155160. ［8］ Moll R, Franke WW， Schiler D L， et al. The catalog of human cytokeratins：patterns of expression in normal epithelial，tumors and cultured cells［J］． Cell, 1982, 3l(1)：1124. ［9］ Galgano MT, Hampton GM, Frierson HF Jr. Comprehensive analysis of HE4 expression in normal and malignant human tissues ［J］. Mod Pathol, 2006, 19(6):847853. ［10］ Wang K, Gan L, Jeffrey E, et al. Monitoring gene expression profile changes in ovarian carcinomas using cDNA microarray［J］. Gene, 1999, 299(12):101108. ［11］ Moore RG, Brown AK, Miller MC, et al. The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass［J］. Gynecol Oncol, 2008, 108(2):402408.

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