血清胃泌素释放肽前体、甲胎蛋白和糖类抗原199单项及联合检测在卵巢癌诊断中的价值

doi:10.16150/j.1671-2870.2019.02.017

摘要/Abstract

摘要：

目的：探讨血清胃泌素释放肽前体（pro-gastrin-releasing peptide, ProGRP）、甲胎蛋白（α-fetoprotein, AFP）、糖类抗原199（carbohydrate antigen 199, CA199）、糖类抗原125（carbohydrate antigen 125, CA125）、人附睾分泌蛋白4（human epididymal protein 4, HE4）单项检测及ProGRP、AFP、CA199联合平行检测对卵巢癌的诊断价值。方法：回顾性分析379例疑诊卵巢癌者的临床病例资料，其中123例患者经病理学明确诊断为卵巢癌（卵巢癌组），另256例为非卵巢癌患者（非卵巢癌组）。比较2组患者的血清ProGRP、AFP、CA199、CA125、HE4水平，探讨血清ProGRP、AFP、CA199、CA125、HE4单项检测及ProGRP、AFP、CA199联合检测诊断卵巢癌的效能，绘制基于血清ProGRP、AFP、CA199、CA125、HE4单项检测及ProGRP、AFP、CA199联合检测诊断卵巢癌的受试者工作特征曲线（receiver operating characteristic curve，ROC曲线），计算ROC曲线下面积（area under the ROC curve, AUC）。结果：卵巢癌组Ⅰ期患者的血清ProGRP、AFP、CA199水平均明显低于Ⅱ~Ⅳ期患者（P<0.05）;卵巢癌组的血清ProGRP、AFP、CA199、CA125及HE4水平均明显高于非卵巢癌组（P<0.05）;血清ProGRP、AFP、CA199、CA125、HE4单项检测诊断卵巢癌的最佳临界值分别为69.21 pg/mL、28.95 ng/mL、42.38 U/mL、57.65 U/mL、125.64 pmol/L，血清ProGRP、AFP、CA199、CA125、HE4单项检测及ProGRP、AFP、CA199联合平行检测诊断卵巢癌的AUC分别为0.786、0.821、0.897、0.912、0.926及0.948，灵敏度分别为78.05%、80.49%、85.37%、88.62%、91.06%及77.24%，特异度分别为85.94%、86.72%、87.89%、90.63%、90.23%及97.27%，准确率分别为83.37%、84.70%、87.07%、89.97%、90.50%及90.77%。结论：血清ProGRP、AFP、CA199、CA125、HE4单项检测及ProGRP、AFP、CA199联合检测在卵巢癌诊断中均具有良好的应用价值，但ProGRP、AFP、CA199联合平行检测的可靠性更佳，可用于卵巢癌筛查工作中。

关键词: 胃泌素释放肽前体, 甲胎蛋白, 糖类抗原199, 卵巢癌, 诊断价值

Abstract:

Objective: To investigate the value of single detection of serum pro-gastrin-releasing peptide (ProGRP), α-fetoprotein (AFP), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4) and combined detection of ProGRP, AFP and CA199 for the diagnosis of ovarian cancer. Methods: Three hundred and seventy nine suspected ovarian cancer patients, including 123 pathologically confirmed cases, admitted from January 2014 to February 2017 and another 256 patients with non-ovarian cancer served as control group were analyzed retrospectively. Serum levels of ProGRP, AFP, CA199, CA125, HE4 in the two groups were compared, and the diagnostic efficacy of single detection of ProGRP, AFP, CA199, CA125, HE4 and combined detection of ProGRP, AFP, CA199 for ovarian cancer was analyzed. ROC curves were plotted based on ProGRP, AFP, CA199, CA125, HE4, and ProGRP, AFP, CA199 combined detection. The AUC under the ROC curve were calculated. Results: The levels of serum ProGRP, AFP and CA199 in patients with stage Ⅰ and Ⅱ of the ovarian cancer were significantly lower than those in stage Ⅲ and Ⅳ(P<0.05). The levels of serum ProGRP, AFP, CA199, CA125 and HE4 of ovarian cancer group were significantly higher than those of the non-ovarian cancer group (P<0.05). The optimal cutoff values of serum ProGRP, AFP, CA199, CA125 and HE4 for diagnosis of ovarian cancer were 69.21 pg/mL, 28.95 ng/mL, 42.38 U/mL, 57.65 U/mL and 125.64 pmol/L, respectively, and the sensitivity of serum ProGRP, AFP, CA199, CA125, HE4 single detection and the combined detection of ProGRP, AFP and CA199 were 78.05%, 80.49%, 85.37%, 88.62%, 91.06% and 77.24%, respectively, the specificity were 85.94%, 86.72%, 87.89%, 90.63%, 90.23% and 97.27%, respectively, the detection accuracy were 83.37%, 84.70%, 87.07%, 89.97%, 90.50% and 90.77%, respectively. The AUC of serum ProGRP, AFP, CA199, CA125, HE4 and combined detection of ProGRP, AFP and CA199 were 0.786, 0.821, 0.897, 0.912, 0.926 and 0.948, respectively. Conclusions: Serum ProGRP, AFP, CA199, CA125, HE4 detection and combined detection of ProGRP, AFP and CA199 all have good performance in the diagnosis of ovarian cancer, and the reliability of combined detection of ProGRP, AFP and CA199 is better, which could be used for screening of ovarian cancer.

Key words: Pro-gastrin-releasing peptide, Alpha fetoprotein, Carbohydrate antigen 199, Ovarian cancer, Diagnostic value

中图分类号:

R737.31

蒋东葵, 陈兆亚, 马冬梅, 徐林, 饶群. 血清胃泌素释放肽前体、甲胎蛋白和糖类抗原199单项及联合检测在卵巢癌诊断中的价值[J]. 诊断学理论与实践, 2019, 18(2): 209-214.

JIANG Dongkui, CHEN Zhaoya, MA Dongmei, XU Lin, RAO Qun. Value of single and combined detection of serum pro-gastrin-releasing peptide, alpha fetoprotein and carbohydrate antigen 199 in diagnosis of ovarian cancer[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(2): 209-214.

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组别	n	ProGRP（pg/mL）	AFP（ng/mL）	CA199（U/mL）
Ⅰ期	38	104.95±8.37	58.79±5.89	103.94±7.69
Ⅱ~Ⅳ期	85	136.51±11.38	72.32±9.88	135.63±12.41
t值		15.238	8.179	14.525
P值		<0.001	<0.001	<0.001

组别	例数	ProGRP（pg/mL）	AFP（ng/mL）	CA199（U/mL）	CA125（U/mL）	HE4（pmol/L）
卵巢癌组	123	126.76±14.53	68.14±10.36	125.84±14.39	341.47±50.68	259.32±45.27
非卵巢癌组	256	58.16±9.47	6.14±1.12	24.35±4.61	65.42±11.38	54.37±10.36
t值		55.057	94.740	102.543	83.011	68.869
P值		<0.001	<0.001	<0.001	<0.001	<0.001