HE4、CA125联合ROMA指数及阴超检查对盆腔肿块的诊断价值

摘要

目的 研究人附睾分泌蛋白4(HE4)、癌抗原125(CA125)联合卵巢癌风险预测模型(ROMA)指数及阴超检查对盆腔肿块的诊断价值.方法 将202例盆腔肿块患者共按照手术和病理诊断结果分为2组.其中良性盆腔肿块组114例,恶性组88例均为卵巢癌患者,同时选取58例健康体检者为健康组,对3组患者进行阴道超声检查,测定血清HE4及CA125测定,根据月经状态计算ROMA指数,并进行统计学比较分析,计算阴道超声评分、HE4、CA125及ROMA指数联合诊断对盆腔恶性肿块诊断的灵敏度和特异度.结果 子宫肌瘤、子宫腺肌病的超声诊断符合率最高,达100% ,其他炎性包块、卵巢囊肿、畸胎瘤、卵巢黏(浆)液性囊腺瘤的超声诊断符合率的与病理诊断比较差异无统计学意义(P>0. 05).恶性组阴道超声评分、HE4、CA125及ROMA指数均高于良性组及健康组,差异有统计学意义(P<0.05);良性组CAl25水平高于健康组(P<0.05),而阴道超声评分、HE4 及ROMA指数差异无统计学意义(P>0. 05). CA125诊断卵巢恶性肿瘤的特异性及阳性预测值较低,HE4的敏感性较低,ROMA指数的敏感性及准确性较低,联合检测对卵巢癌的敏感性(96. 67% )、特异性(97. 36% )、阳性预测值(98. 01% )均较高(P<0. 05).结论 CA125、HE4、ROMA指数并结合阴道超声检测对盆腔肿块患者卵巢癌的筛查有较高的灵敏度和特异性,可作为诊断卵巢癌早期筛查的重要手段.%Objective To investigate the diagnostic value of HE4, CA125 combined with ROMA index and transvaginal ultrasonography in pelvic mass. Methods A total of 202 patients with pelvic masses were divided into benign pelvic mass group (n=114) and malignant pelvic mass group (n=88) according to the results of operation and pathological diagnosis. The patients in malignant pelvic mass group were all the patients with ovarian cancer. At the same time,the other 58 healthy subjects who received physical examination were enrolled as control group. Transvaginal ultrasonography was performed for the three groups. The serum levels of HE4 and CA125 were measured, and the ROMA indexws were calculated according to menstrual status. Moreover the sensitivity and specificity of vaginal ultrasonography scores,detection of HE4, CA125 and ROMA index in diagnosis of pelvic malignant tumor were statistically analyzed and compared among the three groups. Results The diagnose accordance rate of ultrasonography in diagnosis of uterine fibroids and adenomyosis was the highest (100% ). There were no significant differences in the diagnose accordance rate of inflammatory masses, ovarian cysts, teratomas and cystadenoma of ovary mucosa between ultrasonography examination and pathological diagnosis results ( P >0. 05). The vaginal ultrasonography scores, serum levels of HE4, CA125 and ROMA indexes in malignant pelvic mass group were significantly higher than those in benign pelvic mass group and control group(P<0. 05). Moreove the serum level of CA125 in benign pelvic mass group were significantly higher than those in control group (P<0. 05), however there were no significant differences in vaginal ultrasonography scores, serum levels of HE4 and ROMA indexes between benign pelvic mass group and control group (P<0. 05). The specificity and predictive value of CA125 in diagnosis of ovarian malignant tumor were lower,however,and the sensitivity of HE4 was lower,and specificity and accuracy of ROMA index were lower,however, the sensitivity, specificity and positive predictive value by combination detection were higher,hich were 96. 67% ,97. 36% , 98.01%,respectively (P<0. 05). Conclusion The combination detection of serum levels of CA125,HE4, ROMA index combined with vaginal ultrasonography has higher sensitivity and specificity in screening of ovarian cancer in patients with pelvic masses,therefor,which can be regarded as important means in early screening of ovarian cancer.