血清HE4和S CCAg与子宫内膜癌生物学行为的关系

摘要

Objective To investigate human epididymal secretory protein 4 (HE4)and squamous cell carcinoma antigen (SCCAg ) levels in endometrial carcinoma and their relationships with biological behavior of endometrial carcinoma.Methods Serum levels of HE4 and SCCAg were detected by enzyme-linked immunosorbent assay in 85 patients with endometrial carcinoma,30 patients with endometrial atypical hyperplasia and 30 healthy women (control group).The clinical signicance of HE4 and SCCAg were analyzed comparatively.Results Serum levels of HE4 and SCCAg were (199.6 ±31.2)pmol/L and 0.98(0.15-4.85)μg/L in patients with endometrial carcinoma,which were higher than those in patients with endometrial atypical hyperplasia [(91.6 ± 16.8)pmol/L and 0.18(0.02-1.41)μg/L,P<0.05]and control group [(82.5 ±9.7)pmol/L and 0.13(0.03-1.32)μg/L,P<0.05].The diagnosis sensitivities of HE4 and SCCAg for the diagnosis of endometrial carcinoma were 63.5% and 14.1%,and the specificities were 96.7% and 100.0%.Serum HE4 and SCCAg levels and the positive rates had increasing trend with stage rising,and the positive rates in advanced stages of endometrial carcinoma (HE4:90.0% for stage Ⅲ and 100.0% for stage Ⅳ,SCCAg:30.0% for stage Ⅲ and 25.0% for stage Ⅳ),which were higher than those in early stage(61.1% and 5.6%for stageⅠ,P<0.05).For different clinical pathological factors,the positive rate of HE4 in non-endometrial adenocarcinoma was up to 92.0%,which was higher than that in endometrial adenocarcinoma (51.7%,P<0.05).HE4 expression in endometrial carcinoma had the relationship with tumor size,pathological type, depth of tumor invasion and tumor metastasis (P<0.05 ),and SCCAg expression in endometrial carcinoma had the relationship with tumor metastasis only (P <0.01 ).Conclusions Serum HE4 has clinical early diagnosis and identification significance for endometrial carcinoma,and it can be used as an indicator for monitoring endometrial carcinoma.However,SCCAg had a little diagnosis significance for the diagnosis of endometrial carcinoma.It only has a certain significance in the course of monitoring and tumor metastasis identification.%目的：探讨人附睾分泌蛋白4（HE4）和鳞状细胞癌抗原（SCCAg）在子宫内膜癌的表达及两者与子宫内膜癌生物学行为的关系。方法利用酶联免疫吸附试验检测85例子宫内膜癌患者、30例子宫内膜非典型增生患者及30名健康女性（对照组）血清HE4和SCCAg含量，并对比分析两者对子宫内膜癌的临床价值。结果子宫内膜癌组血清HE4和SCCAg水平分别为（199．6±31．2）pmol/L、0．98（0．15～4．85）μg/L，明显高于子宫内膜非典型增生组[（91．6±16．8）pmol/L、0．18（0．02～1．41）μg/L，P均＜0．05]和对照组[（82．5±9．7）pmol/L、0．13（0．03～1．32）μg/L，P均＜0．05]；HE4和SCCAg对子宫内膜癌诊断的敏感性分别为63．5％、14．1％，特异性为96．7％、100．0％；血清HE4和SCCAg水平及阳性率均随临床分期升高逐渐上升，两者在子宫内膜癌晚期的阳性率（HE4：Ⅲ期90．0％、Ⅳ期100．0％；SCCAg：Ⅲ期30．0％、Ⅳ期25．0％）明显高于早期（Ⅰ期分别为61．1％和5．6％，P均＜0．05）；在不同的临床病理因素中，非子宫内膜样腺癌HE4阳性率达92．0％，明显高于子宫内膜样腺癌（51．7，P＜0．05），HE4在子宫内膜癌的表达与肿瘤大小、病理类型、肿瘤侵润肌层深度及肿瘤转移均有关（P均＜0．05）；而SCCAg在子宫内膜癌的表达仅与肿瘤转移有关（P＜0．01）。结论血清HE4检测对子宫内膜癌的早期诊断及鉴别诊断有一定的临床应用价值，可作为子宫内膜癌病程监测的可靠指标。而SCCAg单独作为子宫内膜癌诊断指标尚无太大意义，仅在病程监测及判断肿瘤转移上有一定价值。