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目的探讨联合检测外周血骨桥蛋白(OPN)、人附睾分泌蛋白4(HE4)和端粒酶活性对卵巢癌早期诊断的价值。方法选取2012年9月-2014年8月大庆龙南医院妇产科收治的经病理检查确诊为卵巢癌的50例患者为卵巢癌组,40例卵巢良性肿瘤患者为卵巢良性肿瘤组,40例门诊体检卵巢正常的健康女性为健康对照组。利用酶联免疫吸附法(ELISA)检测所有受试者外周血血清中OPN和HE4水平,利用端粒酶重复序列扩增法(TRAP)检测所有受试者外周血血清中端粒酶活性。结果卵巢癌组OPN和HE4的表达以及端粒酶活性阳性表达率显著高于另外两组(P<0.05),而卵巢良性肿瘤组和对照组OPN和HE4的表达以及端粒酶活性阳性率比较,差异均无统计学意义(P>0.05);单独检测OPN和HE4,灵敏度和特异度均较低,端粒酶活性特异度虽较高,但灵敏度较低;两项指标联合检测,灵敏度和特异度均显著高于单项检测,但约登指数和阳性似然比较低,阴性似然比较高;3项指标联合检测,灵敏度和特异度均在90%以上,且约登指数接近1,阳性似然比≥10.0,阴性似然比≤0.1,各项指标均显著优于其他检测指标(P<0.01)。结论联合检测外周血中OPN、HE4和端粒酶活性对卵巢癌的早期诊断有较高的临床应用价值。
Objective To investigate the value of combined detection of peripheral blood osteopontin (OPN), human epididymis secretory protein 4 (HE4) and telomerase activity in the early diagnosis of ovarian cancer. Methods 50 patients diagnosed as ovarian cancer from Department of Obstetrics and Gynecology, Longnan Hospital, Daqing from September 2012 to August 2014 were selected as ovarian cancer group, 40 benign ovarian tumor patients as ovarian benign tumor group and 40 outpatients Healthy women with normal ovarian status were healthy controls. The peripheral blood serum levels of OPN and HE4 were detected by enzyme-linked immunosorbent assay (ELISA), and telomerase activity was detected by peripheral blood serum of all the subjects by telomerase repeat amplification assay (TRAP). Results The expression of OPN and HE4 and the positive rate of telomerase activity in ovarian cancer group were significantly higher than those in the other two groups (P <0.05). However, the expression of OPN and HE4 and the positive rate of telomerase activity in benign ovarian tumor group and control group (P> 0.05). The sensitivity and specificity of OPN and HE4 alone were lower than those of normal control group, while the specificity of telomerase activity was higher but the sensitivity was lower. The combination of the two indexes of sensitivity and specificity Specificity was significantly higher than the single test, but the Youden index and positive likelihood ratio is low, the negative likelihood ratio is high; the three indicators of joint detection, sensitivity and specificity were more than 90%, and the Youden index was close to 1, positive Likelihood Ratio ≥10.0, Negative Likelihood Ratio ≤0.1, all the indexes were significantly better than other test indexes (P <0.01). Conclusion The combined detection of OPN, HE4 and telomerase activity in peripheral blood has a high clinical value in the early diagnosis of ovarian cancer.