人附睾蛋白4在妇科良性疾病中的评估作用研究

摘要

背景人附睾蛋白4（HE4）是一种新兴的用于监测上皮性卵巢癌的血清肿瘤标志物之一，被逐渐应用并推广于临床。目的通过测量血清 HE4及糖类抗原125（CA125）在妇科常见疾病中的水平，阐述 HE4及 CA125在临床应用中的意义。方法选取2014年6月—2015年8月就诊于石河子大学医学院第一附属医院因盆腔良性包块行妇科手术治疗的患者340例，并获得其术后病理结果。患者均于术前15 d 内抽取血液，检测血清 HE4和 CA125水平。血清 CA125参考值为35.00 U/ ml；血清 HE4参考值为105.10 pmol/ L，表观健康绝经前与绝经后妇女 HE4参考值分别为68.00 pmol/ L 和114.00 pmol/ L。比较分析两项肿瘤标志物在不同妇科疾病中的水平。结果340例盆腔良性疾病患者包括子宫良性疾病134例（子宫组），其中子宫肌瘤101例，子宫腺肌症15例，其他子宫良性疾病18例；卵巢良性肿瘤178例（卵巢组），其中子宫内膜异位囊肿66例，成熟型畸胎瘤40例，良性上皮性肿瘤52例，其他卵巢良性肿瘤20例；盆腔炎性疾病28例（炎症组）。子宫肌瘤患者和子宫腺肌症患者血清 CA125水平比较，差异有统计学意义（U =243.500，P 0.05）。279例绝经前患者血清 HE4和 CA125水平升高的发生率比较，差异有统计学意义（ P 0.05）。结论 HE4及 CA125联合能更好地鉴别子宫肌瘤及子宫腺肌症；在子宫肌瘤、子宫内膜异位囊肿中血清 HE4水平的升高比例较 CA125升高比例低，因此 HE4是评估妇科疾病良恶性一项非常有前景的肿瘤标志物。%Backgroud Human epididymis protein 4( HE4) is a novel biomarker for the monitoring on epithelial ovarian cancer and is gradually being applied and promoted in clinical practice. Objective To explore the significance of HE4 and CA125 in clinical application by measuring serum HE4 and CA125 levels in patients with common gynecological diseases. Methods We enrolled 340 patients who underwent gynecological operation due to pelvic benign bag piece in the First Affiliated Hospital of Medical College of Shihezi University from June 2014 to August 2015,and the postoperative pathological results were obtained. Blood samples were taken 15 days before surgery,and the levels of serum HE4 and CA125 were detected. The reference value of serum CA125 was 35. 00 U/ ml,and the reference value of serum HE4 was 105. 10 pmol/ L. The reference values of HE4 of premenopausal and postmenopausal women with healthy appearance were 68. 00 pmol/ L and 114. 00 pmol/ L respectively. The levels of the two tumor markers in the cases of different diseases were compared and analyzed. Results Among the 340 patients with pelvic benign diseases,there were 134 patients with benign uterine diseases( uterine group) including 101 patients with uterine fibroid,15 patients with adenomyosis of uterus and 18 patients with other benign uterine diseases;there were 178 patients with benign ovarian tumor(ovary group)including 66 patients with ovarian endometrial cyst, 40 patients with mature teratoma,52 patients with benign epithelial tumors and 20 patients with other benign ovarian tumors;and there were 28 patients with pelvic inflammatory diseases(inflammation group). Patients with uterine fibroid and patients with adenomyosis of uterus were significantly different in serum CA125 level( U = 243. 500,P 0. 05). There was significant difference between the incidence of serum HE4 level elevation and that of CA125 level in 279 premenopausal patients(P 0. 05). Conclusion HE4 combined with CA125 can better identify uterine fibroid and adenomyosis. The incidence of HE4 level elevation is lower than that of CA125 elevation in patients with uterine fibroids and ovarian endometriosis cyst,thus HE4 level is a promising tumor marker to evaluate benign and malignant gynecological diseases.