不同绝经状态女性血清HE4、CA125和ROMA指数在卵巢癌诊断中的意义
The significance of serum HE4, CA125 and ROMA indexes in diagnosis of ovarian cancer to different menopausal status

摘要：目的 根据女性绝经状态不同评价人附睾蛋白4(HE4)、糖类抗原125(CA125)和ROMA指数在诊断卵巢癌方面的应用价值和意义。方法 选取妇科包块患者进行手术，确诊为卵巢癌的患者73例(卵巢癌组，分为早期和晚期)，卵巢良性肿瘤患者66例(良性肿瘤组)以及健康妇女57例(健康对照组)为研究对象，每组进一步分为未绝经组和绝经组。采用化学发光免疫分析法测定血清HE4和CA125水平，并计算ROMA指数。结果 ①卵巢癌组的HE4、CA125和ROMA水平均高于良性肿瘤组和健康对照组，有统计学意义(P<0.01)；②受试者工作特征(ROC)曲线分析表明，以良性肿瘤组+健康对照组为参照，未绝经组与绝经组HE4、CA125和ROMA曲线下面积(AUC)分别为0.944、0.822、0.941 vs. 0.994、1.000、1.000；③在未绝经组，HE4的特异度及阳性预测值最高，最佳cut off值为75.92pmol/mL时诊断灵敏度和特异度分别为73.1%和100%；在绝经组，CA125具有较高的灵敏度，最佳cut off值为57.65U/mL时诊断灵敏度和特异度分别为100%和95.4%；④血清CA125在绝经组早晚期组比较差异无统计学意义(P>0.05)。结论 在未绝经组中HE4具有更好的鉴别诊断价值，在绝经组ROMA指数能兼顾灵敏度和特异度，具有较高的诊断效能。根据绝经状态不同建立HE4、CA125和ROMA指数的参考区间，在卵巢癌诊断中有一定的临床意义。
ABSTRACT: Objective To evaluate the significance of HE4, CA125 and ROMA indexes in the diagnosis of ovarian cancer in different menopausal status women. Methods After the gynecological mass was taken for pathological diagnosis, a total of 73 cases of ovarian cancer (ovarian cancer group，divided into early stage and late stage) and 66 cases of gynecological benign tumor (benign tumor group) were selected. 57 healthy women were selected as controls (control group). All groups were further divided into non-menopausal and postmenopausal groups. Serum levels of HE4 and CA125 were measured by chemiluminescence immunoassay and the ROMA index was calculated. Results ① The serum levels of HE4, CA125 and ROMA in ovarian cancer group were significantly higher than those in benign tumor group and healthy control group (P<0.01). ② When benign tumor group and control group were taken as a reference, the receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of HE4, CA125 and ROMA in the non-menopausal group and the postmenopausal group was (0.944, 0.822, 0.941 vs. 0.994, 1.000, 1.000), respectively. ③ In non-menopausal group, HE4 has higher specificity and positive predictive value. The best cut off value was 75.92pmol/mL, the diagnostic sensitivity and specificity were 73.1% and 100%. In postmenopausal group, CA125 has higher sensitivity, the optimum cut off value was 57.65U/mL, the diagnostic sensitivity and specificity were 100% and 95.4%. ④ In the postmenopausal group, there was no significant difference in serum CA125 level between the early and late ovarian cancer patients (P>0.05). Conclusion In the premenopausal group HE4 has a better differential diagnostic value. In postmenopausal group, the ROMA index could give consideration to both sensitivity and specificity, and had higher diagnostic efficacy. It plays roles in the diagnosis of ovarian cancer to establish the