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血清HE4、CA125和YKL-40联合检测在上皮性卵巢癌诊断中的临床价值

发布时间:2018-06-08 21:15

  本文选题:甲壳质酶蛋白40(YKL-40) + 人附睾蛋白4(HE4) ; 参考:《山西医科大学》2014年硕士论文


【摘要】:目的:通过应用酶联免疫法(ELISA)检测血清中人附睾蛋白4(human epididymis protein4,HE4)、 CA125和人类软骨糖蛋白39(human cartilageglycopmtein,YKL-40)在正常对照组妇女、良性卵巢上皮性肿瘤患者、卵巢上皮性癌患者的表达水平,探讨这三项标志物单独和联合检测在卵巢上皮性癌中诊断与预后的临床价值。 方法:1.收集在山西省肿瘤医院收治的经病理诊断确诊的上皮性卵巢癌患者40例、40例卵巢良性肿瘤患者术前血清及同期在山西省肿瘤医院体检中心体检的40例健康妇女的血清。应用酶联免疫吸附(Enzyme-linked Immunosorbent Assay,ELISA)双抗体夹心法检测血清中HE4、CA125和YKL-40水平,分析比较各组中三项指标的水平及上皮性卵巢癌组中Ⅰ/Ⅱ期和Ⅲ/Ⅳ期之间各指标的水平,以及观察上皮性卵巢癌组中患者手术前后三项指标的水平变化。 2.以健康组和上皮性卵巢良性肿瘤组总体作为参考,,分析HE4、CA125和YKL-40诊断卵巢癌的能力,确定血清HE4、CA125和YKL-40最佳界值点。 3.比较血清HE4、CA125和YKL-40单项或联合检测上皮性卵巢癌的敏感度。 4.应用SPSS13.0统计软件进行统计学分析。 结果:1.血清YKL-40在正常对照组妇女、良性卵巢上皮性肿瘤患者、卵巢上皮性癌患者的浓度均数分别为35.53ng/ml、43.85ng/ml、106.14ng/ml,各组HE4的浓度均数分别为44.16pmol/L、81.81pmol/L、178.13pmol/L,各组CA125的浓度均数分别为24.21U/mL、62.75U/mL、242.03U/mL。健康对照组、上皮性良性卵巢肿瘤组及上皮性卵巢癌组血清中的HE4、CA125和YKL-40表达水平比较:三组血清的HE4、CA125和YKL-40差异均有统计学意义(p0.001),上皮性卵巢癌组血清中三项标记物表达水平都明显高于健康组和良性组,进一步进行LSD-t多重比较得,HE4、CA125和YKL-40在卵巢上皮癌组的表达水平均高于其他两组(p0.05),HE4和CA125在上皮性良性卵巢肿瘤组的表达水平均高于健康对照组(p0.05),YKL-40在上皮性良性卵巢肿瘤组与健康对照组的表达水平差异无统计学意义(p0.05)。并且上皮性卵巢癌组中Ⅰ/Ⅱ期与Ⅲ/Ⅳ期中血清HE4、CA125和YKL-40的表达水平比较:血清HE4水平在Ⅰ/Ⅱ期与Ⅲ/Ⅳ比较差异有统计学意义(t7.833,P 0.001),血清CA125水平在Ⅰ/Ⅱ期与Ⅲ/Ⅳ比较差异有统计学意义(t12.98, P0.001),血清YKL-40水平在Ⅰ/Ⅱ期与Ⅲ/Ⅳ比较差异有统计学意义(t6.786,P 0.001)。 2.上皮性卵巢癌组手术前后血清HE4、CA125和YKL-40的表达水平比较:手术前后血清HE4、CA125和YKL-40的表达水平差异均有统计学意义(p0.05),手术后血清HE4、CA125和YKL-40的表达水平均低于手术前的。 3.以正常对照组+上皮性良性卵巢肿瘤组作参照,分别绘制HE4、CA125和YKL-40的ROC曲线,在(敏感性+特异性)-1取值最大处为其最佳界值点。卵巢癌患者血清中HE4、CA125和YKL-40最佳临界点,根据ROC曲线的Youden指数,可得HE4、CA125、YKL-40的最佳临界点分别为103.5、95.6、59.975。即在该点它们的诊断价值最大。 4.血清中HE4、CA125和YKL-40分别以它们的最佳界值点作为阳性标准值范围,即HE4浓度大于103.5pmol/L时诊断为阳性,CA125浓度大于95.6U/mL时诊断为阳性,YKL-40浓度大于59.975ng/mL时诊断为阳性,单独或联合检测血清HE4、CA125和YKL-40水平来评价诊断上皮性卵巢癌的功效。 5.上皮性卵巢癌患者血清中HE4、CA125和YKL-40灵敏度、特异度比较:三项指标联合检测的灵敏度高于单项指标,特异度低于单项指标,HE4的灵敏度和特异度均较好。 结论:1.上皮性卵巢癌患者血清中HE4、CA125和YKL-40水平明显高于上皮性良性肿瘤组和健康对照组水平,然而HE4和CA125在上皮性良性卵巢肿瘤组的表达水平均高于健康对照组,而YKL-40在上皮性良性卵巢肿瘤组与健康对照组的表达水平差异无统计学意义,提示YKL-40有可能成为卵巢癌筛查的标志物。 2.上皮性卵巢癌患者治疗前后血清HE4、CA125和YKL-40水平的比较:卵巢癌患者术后血清HE4、CA125和YKL-40的水平显著低于术前的水平,差异具有统计学意义。提示上皮性卵巢癌患者术前血清中HE4、CA125和YKL-40水平有望成为筛查卵巢癌的标志物,在卵巢癌的筛查中起到重要作用,因此能协助卵巢癌的诊断;上皮性卵巢癌患者术后血清中HE4、CA125和YKL-40水平可能成为卵巢癌临床手术疗效判断及术后病情监测的有前景的指标。 3.卵巢癌患者血清HE4、CA125和YKL-40检测的灵敏度分别为92.5%、90%和82.5%,特异性分别为93.8%、95%和95%,三项指标联合检测的灵敏度和特异性为97.5%和85%,三项指标联合检测的灵敏度高于单项检测,特异度低于单项指标,而HE4的灵敏度和特异度均较好。提示联合检测HE4、CA125和YKL-40能够提高卵巢癌的诊断率,而血清HE4在卵巢癌诊断中有重要意义。
[Abstract]:Objective: to detect the expression levels of human epididymal protein 4 (human epididymis protein4 (HE4), CA125 and human cartilage glycoprotein 39 (human cartilageglycopmtein, YKL-40) in normal control women, benign ovarian epithelial tumor patients and ovarian epithelial cancer patients by enzyme linked immunosorbent assay (ELISA), and explore these three markers. The clinical value of combined detection of single and combined agents in diagnosis and prognosis of epithelial ovarian cancer.
Methods: 1. 40 cases of epithelial ovarian cancer diagnosed by pathological diagnosis in Shanxi cancer hospital were collected, serum of 40 cases of benign ovarian tumors and 40 healthy women in the physical examination center of Shanxi cancer hospital were collected at the same time. Enzyme-linked Immunosorbent Assay (ELISA) double resistance was used. The level of HE4, CA125 and YKL-40 in serum was detected by the body sandwich method. The level of three indexes in each group and the level of each index in the stage I / II and stage III / IV of the epithelial ovarian cancer group were compared and the level of the three indexes before and after the operation in the epithelial ovarian cancer group were observed.
2. the ability of HE4, CA125 and YKL-40 to diagnose ovarian cancer was analyzed with the health group and the epithelial ovarian benign tumor group as a whole. The best boundary value of serum HE4, CA125 and YKL-40 was determined.
3. to compare the sensitivity of serum HE4, CA125 and YKL-40 to detect epithelial ovarian cancer individually or jointly.
4. SPSS13.0 statistical software was used for statistical analysis.
Results: 1. the concentrations of serum YKL-40 in the normal control group, the benign ovarian epithelial tumor and the ovarian epithelial cancer were 35.53ng/ml, 43.85ng/ml, 106.14ng/ml respectively. The concentration of HE4 in each group was 44.16pmol/L, 81.81pmol/L, 178.13pmol/L, and the concentrations of CA125 were 24.21U/mL, 62.75U/mL, and 242.03U/mL. The expression levels of HE4, CA125 and YKL-40 in the serum of the healthy control group, the epithelial ovarian tumor group and the epithelial ovarian cancer group were compared: the differences of serum HE4, CA125 and YKL-40 in the three groups were statistically significant (p0.001). The expression level of the three markers in the serum of the epithelial ovarian cancer group was significantly higher than that in the healthy group and the benign group. The expression level of HE4, CA125 and YKL-40 in the ovarian epithelial cancer group was higher than that of the other two groups (P0.05). The expression level of HE4 and CA125 in the epithelial benign ovarian tumor group was higher than that of the healthy control group (P0.05), and there was no significant difference in the expression level of YKL-40 in the epithelial benign ovarian tumor group and the healthy control group (p0.0, p0.0). 5) and the expression level of serum HE4, CA125 and YKL-40 in stage I / II and stage III / IV of epithelial ovarian cancer group: the level of serum HE4 was statistically significant (t? 7.833, P 0.001) in phase I / II (t? 7.833, P 0.001), and the serum CA125 level was statistically significant (t? 12.98, P0.001) and serum YKL-40 level in stage I / II period (t? 12.98). There was a statistically significant difference between stage I / II and III / IV (t? 6.786, P 0.001).
The expression level of serum HE4, CA125 and YKL-40 before and after operation in 2. epithelial ovarian cancer group: the difference of serum HE4, CA125 and YKL-40 expression level before and after operation was statistically significant (P0.05). The expression level of serum HE4, CA125 and YKL-40 after operation was lower than that before operation.
3. the ROC curves of HE4, CA125 and YKL-40 were plotted in the normal control group and the epithelial benign ovarian tumor group. The optimum boundary point was the maximum value of the (sensitivity + specific) -1 value. The optimal critical point of HE4, CA125 and YKL-40 in the serum of the ovarian cancer patients could be obtained according to the Youden index of the ROC curve, and the best critical points of HE4, CA125 and YKL-40 were obtained. 103.5,95.6,59.975. is the most valuable diagnostic point at this point.
4. HE4, CA125 and YKL-40 were used as positive standard values in their best boundary value points, that is, HE4 was positive when the concentration of HE4 was greater than 103.5pmol/L, and the diagnosis was positive when the concentration of CA125 was greater than 95.6U/mL. The diagnosis was positive when the concentration of YKL-40 was greater than 59.975ng/mL, and the diagnostic value of serum HE4, CA125 and YKL-40 levels was evaluated separately or jointly. The efficacy of skin ovarian cancer.
The sensitivity and specificity of serum HE4, CA125 and YKL-40 in patients with epithelial ovarian cancer were compared: the sensitivity of the combined detection of the three indexes was higher than that of the single index, and the specificity was lower than the single index, and the sensitivity and specificity of HE4 were all better.
Conclusion: the levels of HE4, CA125 and YKL-40 in serum of patients with epithelial ovarian cancer were significantly higher than those in the epithelial benign tumor group and the healthy control group. However, the expression level of HE4 and CA125 in the epithelial benign ovarian tumor group was higher than that in the healthy control group, and the expression level of YKL-40 in the epithelial benign egg nest tumor group and the healthy control group was poor. The difference was not statistically significant, suggesting that YKL-40 may be a marker for ovarian cancer screening.
The comparison of serum HE4, CA125 and YKL-40 levels before and after treatment in patients with epithelial ovarian cancer: the levels of serum HE4, CA125 and YKL-40 in patients with ovarian cancer were significantly lower than those before the operation, and the difference was statistically significant. It is suggested that the serum levels of HE4, CA125 and YKL-40 in the serum of patients with epithelial ovarian cancer are expected to be a sign of screening ovarian cancer before operation. It plays an important role in the screening of ovarian cancer, thus assisting the diagnosis of ovarian cancer. The serum levels of HE4, CA125 and YKL-40 in patients with epithelial ovarian cancer may be a promising indicator of the clinical operation and postoperative monitoring of ovarian cancer.
The sensitivity of serum HE4, CA125, and YKL-40 in patients with ovarian cancer was 92.5%, 90%, and 82.5%, and the specificity was 93.8%, 95% and 95%, respectively. The sensitivity and specificity of the combined detection were 97.5% and 85%, and the sensitivity of the three indexes was higher than the single test, and the specificity was lower than the single index, while the sensitivity and specificity of the HE4 were both. It suggests that combined detection of HE4, CA125 and YKL-40 can improve the diagnostic rate of ovarian cancer. Serum HE4 is of great importance in the diagnosis of ovarian cancer.
【学位授予单位】:山西医科大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R737.31

【参考文献】

相关期刊论文 前3条

1 崔恒;;卵巢癌的诊治及其研究策略[J];中国妇产科临床杂志;2006年05期

2 范江涛;李力;;血清甲壳质酶蛋白40诊治妇科恶性肿瘤研究[J];国际妇产科学杂志;2008年02期

3 刘润幸;使用SPSS作多变量观察值的ROC曲线分析[J];中国公共卫生;2003年09期



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