CAJ | 학술논문

目的：探讨血清人附睾蛋白4（HE4）、细胞角蛋白19片段抗原21-1（CYFRA21-1）、CA125对卵巢良、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）检测来威海市文登中心医院就诊的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、CA125水平，其中任一指标高于正常上限即定为阳性，分析三者在卵巢癌诊断中的阳性率及符合率，比较三种指标对卵巢良、性肿瘤的诊断价值。结果 HE4和CYFRA21-1水平在卵巢癌组显著升高，与良性肿瘤和健康对照组比较差异有统计学意义（P﹤0.05），而良性肿瘤与对照组比较差异无统计学意义（P﹥0.05）；对于恶性肿瘤两者诊断的特异性和阳性预测值都很高[ HE4（100%，100%），CYFRA21-1（98.2%，96.7%）]，诊断的符合率也比较高（90.1%，83.2%），与CA125相比差异有统计学意义（ P﹤0.05），但两者的敏感性比CA125低。CA125在卵巢良、恶性肿瘤中都会升高，只是升高的程度不同，恶性肿瘤组与良性肿瘤组比较、良性肿瘤组与正常对照组比较差异均有统计学意义（ P均﹤0.05），能简单区分良、恶性肿瘤；但对卵巢癌诊断的特异性不是很高（75%），阳性预测值和诊断符合率也比较低（72%，77.2%），三者联合检测可以提高卵巢癌诊断的敏感性（100%）及准确性（85.1%），达到优化临床诊断的效果。结论 HE4、CYFRA21-1只在恶性肿瘤中升高，主要用于卵巢癌的诊断；CA125在良、恶性肿瘤中都有升高，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。
목적：탐토혈청인부고단백4（HE4）、세포각단백19편단항원21-1（CYFRA21-1）、CA125대란소량、악성종류진단적의의，평개기단독급연합검측재판단란소암고풍험중적개치。방법채용전화학발광면역법（ ECL）검측래위해시문등중심의원취진적45례원발성란소암、56례량성란소종류환자급50례건강체검녀성혈청중HE4、CYFRA21-1、CA125수평，기중임일지표고우정상상한즉정위양성，분석삼자재란소암진단중적양성솔급부합솔，비교삼충지표대란소량、성종류적진단개치。결과 HE4화CYFRA21-1수평재란소암조현저승고，여량성종류화건강대조조비교차이유통계학의의（P﹤0.05），이량성종류여대조조비교차이무통계학의의（P﹥0.05）；대우악성종류량자진단적특이성화양성예측치도흔고[ HE4（100%，100%），CYFRA21-1（98.2%，96.7%）]，진단적부합솔야비교고（90.1%，83.2%），여CA125상비차이유통계학의의（ P﹤0.05），단량자적민감성비CA125저。CA125재란소량、악성종류중도회승고，지시승고적정도불동，악성종류조여량성종류조비교、량성종류조여정상대조조비교차이균유통계학의의（ P균﹤0.05），능간단구분량、악성종류；단대란소암진단적특이성불시흔고（75%），양성예측치화진단부합솔야비교저（72%，77.2%），삼자연합검측가이제고란소암진단적민감성（100%）급준학성（85.1%），체도우화림상진단적효과。결론 HE4、CYFRA21-1지재악성종류중승고，주요용우란소암적진단；CA125재량、악성종류중도유승고，단승고적정도불동，가용우량、악성종류적진단여감별，삼자연합검측칙가제고란소암진단적민감성화준학솔，대우란소암적조기진단여치료감측유중요적의의。
Objective To investigate the diagnosis significance of serum HE4 ,CYFRA21-1 , CA125 levels for the benign and malignant varian tumor,and evaluate the value of single detection and combined detection on judging the high risks of ovarian cancer. Methods A total of 45 patients with primary ovarian cancer and 56 patients with benign varian tumor and 50 healthy subjects admitted in Wendeng central hospital whose serum levels of HE4 ,CYFRA21-1 and CA125 were detected by electro-chemiluminescence( ECL),any index above the normal limit was setting for positive,the positive rate and coincidence rate of the three indexes in diagnosis of ovarian cancer was analyzed,and the diagnosis values of three indexes in the benign and malignant varian tumors were compared. Results HE4 and CYFRA21-1 levels of ovarian cancer group were significantly higher,compared with the benign tumor group,and healthy contol group and the differences were statistically significant( P ﹤0. 05 ),however there was no significant difference between benign tumor group and control group( P﹥0. 05 ),for the ma-lignant tumors the specificity and positive predictive value were very high[ HE4( 100%,100%),CY-FRA21-1(98. 2%,96. 7%)]and the diagnostic accuracy was relatively high(90. 1%,83. 2%),com-pared with CA125 the difference was significant( P﹤0. 05 ),but both of them the sensitivity was lower than CA125. The CA125 levels were all increased in benign and malignant tumor,only the extent was different,there was significant difference between them(P﹤0. 05)and the difference was also statistical-ly significant in benign and control group( P﹤0. 05 ),which can simply distinguish benign and malignant tumors, however the specificity for the diagnosis of ovarian cancer is not very high (75%)and the positive predictive value and diagnostic accuracy was also relatively low( 72%, 77. 2%),The sensitivity and accuracy of diagnosis was improved by combining the three indexes and the clinical diagnosis was optimized. Conclusions HE4 ,CYFRA21-1 levels are only increased in malig-nant tumors,and they are mainly used for the diagnosis of ovarian cancer,CA125 levels are all in-creased in benign and malignant tumors,only the extent is different and it can be used for distinguis-hing and diagnosing of benign and malignant tumors. Combining the three indexes can improve the sensitivity and accuracy of the diagnosis of ovarian cancer,and it has important significance for the early diagnosis and treatment of ovarian cancer.