联合检测血清 HE4、SM RP 、CEA 与 CA125在卵巢癌诊断中的应用价值研究

摘要

目的：检测卵巢癌患者血清人附睾蛋白4（HE4）、可溶性间皮素相关蛋白（SMRP）、癌胚抗原（CEA）、糖类抗原125（CA125）的表达水平，并对四项标志物单独和联合检测结果进行统计比较，探讨它们在卵巢癌诊断中的临床应用价值。方法收集65例卵巢癌患者和70例健康体检者空腹静脉血清，ELISA法检测 HE4、SMRP ，化学发光法检测CEA、CA125。结果与健康对照组相比，卵巢癌组血清 HE4、SMRP、CEA、CA125表达水平均较高，差异有统计学意义（P＜0．05）。HE4、SMRP诊断卵巢癌的敏感度较高，其中 HE4明显高于CEA ，差异有统计学意义（P＜0．05）；CA125、HE4诊断特异度较高，均明显高于SMRP ，差异有统计学意义（P＜0．05）；准确度检测中，各指标间差异无统计学意义（P＞0．05），其中HE4和CA125诊断准确度高于其他指标。CA125与HE4组合联检时，敏感度提高，差异具有统计学意义（P＜0．05），但同时特异度明显降低（P＜0．05）；CA125、HE4、SMRP三项组合联检时，敏感度得到更大提高（P＜0．05），达到78．46％，特异度较CA125单独检测仍有降低，但差异无统计学意义（P＞0．05）；同时准确度得到了提高，高达80．74％；CA125、HE4、SMRP、CEA联合检测各项诊断效率指标变化均无统计学意义（P＞0．05）。结论联合检测CA125、HE4以及SMRP能有效提高单独检测时卵巢癌的诊断效率指标，临床工作中将 HE4、CA125、SMRP这几项标志物进行联合检测有助于卵巢癌的筛查和早期诊断。%Objective To detect the serum levels of human epididymis protein 4(HE4) ,soluble mesothelin re‐lated proteins (SMRP) ,carcinoembryonic antigen (CEA) and carbohydrate antigen 125 (CA125) in ovarian cancer , and to conduct the statistical comparison on the detection results of single and combined detection of these four mark‐ers and to explore their clinical application value in the diagnosis of ovarian cancer .Methods The fasting venous ser‐um was collected in 65 patients with ovarian cancer and 70 individuals undergoing the healthy physical examination . HE4 and SMRP were detected by ELISA ;CEA and CA125 were detected through electro‐chemiluminescence meth‐od .Results The expression levels of serum HE4 ,SMRP ,CEA and CA125 in the ovarian cancer group were higher than those in the healthy control group ,and the differences were statistically significant (P<0 .05);the sensitivity of HE4 and SMRP for diagnosing ovarian cancer were higher ,in which HE4 was significantly higher than CEA ,the difference was statistically significant(P<0 .05) than other indicators ,and HE4 was much higher than CEA ,differ‐ence had statistic significance (P<0 .05) .The specificity of CA125 and HE4 were higher than SMRP (P<0 .05);CA125 and HE4 had higher diagnosis specificity ,which were significantly higher than SMRP with statistical differ‐ence(P<0 .05);in the accuracy detection ,the difference among various indicators had no statistical significance(P>0 .05) ,in which the diagnosis accuracy of HE4 and CA125 was higher than that of other indicators .In the combined detection of HE4 and CA125 ,the sensitivity was increased with statistical difference(P<0 .05) ,meanwhile the speci‐ficity was significantly decreased(P< 0 .05);in the combined detection of CA125 ,HE4 and SMRP ,the sensitivity was greatly increased and reached to 78 .46% .But its specificity was still decreased compared with the CA125 single detection ,but the difference was not statistically significant (P>0 .05) .Meanwhile ,its accuracy was increased and up to 80 .74% ;the change of various diagnosis efficiency indicators of CA125 ,HE4 ,SMRP and CEA combined detection had no statistical significance .Conclusion The combined detection of CA125 ,HE4 and SMRP could effectively in‐crease the diagnosis efficiency indicators than their single detection .In the clinical work ,the combined detection of CA125 ,HE4 and SMRP is conducive to the screening and early diagnosis of ovarian cancer .