广州医科大学学报

目的:探讨血清人附睾分泌蛋白4(HE4)和血管内皮生长因子(VEGF)联合预测卵巢癌疾病临床转归的价值。方法:选取2008年1月至2009年12月期间本院收治的卵巢癌患者48例作为观察组,另选取30例同期同龄健康志愿者作为对照。采用ELISA法检测两组血清HE4和VEGF水平。卵巢癌患者均根据病情进行手术治疗,并于术后1、3、5、7和10 d复查以上项目。统计患者5年内复发情况和无疾病进展生存期(DFS)等临床转归情况、比较不同临床转归情况患者的血清HE4和VEGF水平并采用ROC曲线分析卵巢癌患者血清HE4和VEGF水平联合预测其临床转归情况的价值。结果:与对照组比较,观察组术前血清HE4和VEGF水平均明显升高(P<0.05);与术前比较,观察组术后7、10 d的血清HE4和VEGF水平显著降低(P<0.05)。观察组复发率为60.42%,平均DFS为(3.11±1.69)年。与未复发患者和DFS长于平均值患者比较,复发患者和DFS短于平均值患者术前和术后血清HE4和VEGF水平均升高,差异有统计学意义(P<0.05)。血清HE4和VEGF水平联合预测卵巢癌复发和DFS的ROC曲线下面积、敏感度、特异度和准确性均高于血清HE4水平或血清VEGF水平单独预测卵巢癌临床转归情况。结论:卵巢癌患者血清HE4和VEGF水平较高,血清HE4和VEGF水平联合预测卵巢癌疾病临床转归的准确性高,出现血清HE4和VEGF水平升高的卵巢癌患者需警惕其不良临床转归情况的出现并及时干预以改善患者疾病临床转归。

Objective: To investigate the prediction value of serum human epididymis secretory protein 4( HE4) and vascular endothelial growth factor( VEGF) on clinical outcomes in patients with ovarian cancer.Methods: Forty-eight patients with ovarian cancer hospitalized in our hospital between January,2008 and December 2009 were included in the study group,and a contemporary cohort of 30 healthy volunteers of the same age was included in the control group. Enzyme-linked immuno sorbent assay( ELISA) method was used to measure serum HE4 and VEGF levels in the two groups. All ovarian cancer patients underwent surgery according to their disease condition. Then,serum HE4 and VEGF levels were measured for reexamination at 1 d,3 d,5 d,7d and 10 d after the operation. The reoccurrence rate,disease free survival( DFS),and other clinical outcomes in5 years were statistically analyzed. The serum HE4 and VEGF levels in patients with different clinical outcomes were compared. ROC curve was used to analyze the prediction value of serum HE4 and VEGF levels on the clinical outcomes in patients with ovarian cancer. Results: Compared with the control group,the preoperative serum HE4 and VEGF levels in the study group were significantly increased( P < 0. 05). The serum HE4 and VEGF levels in the study group at 7d and 10 d after the operation significantly decreased compared with those before the operation( P<0.05). The recurrence rate and mean DFS in the study group was 60.42% and( 3.11±1. 69) years,respectively. The preoperative and postoperative serum HE4 and VEGF levels in patients with DFS shorter than mean level and reoccurrence significantly increased compared with those in patients with no reoccurrence and DFS longer than mean level,and the differences were statistically significant( P < 0. 05). Area under the ROC curve,sensitivity,specificity and accuracy of ovarian cancer recurrence and DFS predicted by serum HE4 and VEGF levels were all higher than those clinical outcomes of ovarian cancer predicted by serum HE4 or serum VEGF level alone. Conclusion: The serum HE4 and VEGF levels in patients with ovarian cancer are high. The accuracy of serum HE4 and VEGF levels in predicting clinical outcomes of ovarian disease is high.Thus,ovarian cancer patients with increased serum HE4 and VEGF levels should be alert to the occurrence of adverse clinical outcomes,with timely intervention and improvement.