血清脂联素、骨桥蛋白和 HE4 在子宫 内膜癌患者中的表达及意义

Expression and Significance of Serum Adiponectin, Osteopontin and HE4 in Patients with Endometrial Cancer

摘要:

〔摘 要〕 目的：探讨血清脂联素（APN）、骨桥蛋白（OPN）和人附睾分泌蛋白 4（HE4）在子宫内膜癌患者中 的表达及意义。 方法：选取 2019 年 11 月至 2022 年 9 月郴州市第一人民医院收治的子宫内膜癌患者 62 例（子宫内 膜癌组），另选取同期 50 例子宫内膜不典型增生患者（内膜增生组）和 50 例健康志愿者（正常内膜组）。检测并 比较三组血清 APN、OPN、HE4 水平，采用受试者工作特征（ROC）曲线分析血清 APN、OPN、HE4 对子宫内膜癌 的诊断效能，并采用 Spearman 相关性分析探讨血清 APN、OPN、HE4 与临床病理特征的相关性。 结果：子宫内膜癌 组患者血清 APN 水平低于内膜增生组和正常内膜组，OPN、HE4 水平高于内膜增生组和正常内膜组。国际妇产科联 盟（FIGO）分期为 Ⅲ 期患者血清 APN 水平低于 Ⅱ 期和 Ⅰ 期患者，OPN、HE4 水平高于 Ⅱ 期和 Ⅰ 期患者；肌层浸润 深度≥ 1/2 肌层患者血清 APN 水平低于＜ 1/2 肌层患者，OPN、HE4 水平高于＜ 1/2 肌层患者；淋巴结转移患者血清 APN 水平低于无淋巴结转移患者，OPN、HE4 水平高于无淋巴结转移患者，差异均具有统计学意义（P ＜ 0.05）。 ROC 曲线分析显示，血清 APN、OPN、HE4 联合检测诊断子宫内膜癌的曲线下面积为 0.936，灵敏度为 91.7 %，特 异度为 88.1 %，均高于血清 APN、OPN、HE4 单独检测。Spearman 相关性分析显示，血清 APN 与 FIGO 分期、肌层 浸润深度及淋巴结转移呈负相关；血清 OPN、HE4 与 FIGO 分期、肌层浸润深度及淋巴结转移呈正相关。 结论：血 清 APN、OPN、HE4 在子宫内膜癌发生、发展中起重要作用，其表达与子宫内膜癌临床分期、肌层浸润深度及淋巴 结转移存在明显相关性，且联合检测能提高子宫内膜癌的诊断效能。

Abstract:

〔Abstract〕 Objective To investigate the expression and significance of serum adiponectin (APN), osteopontin (OPN) and human epididymis secreted protein 4 (HE4) in patients with endometrial cancer. Methods A total of 62 patients with endometrial cancer (endometrial cancer group), 50 patients with endometrial dysplasia (endometrial hyperplasia group) and 50 healthy volunteers (normal endometrial group) were selected from Chenzhou First People's Hospital from November 2019 to September 2022. Serum levels of APN, OPN, HE4 were detected and compared among the three groups. The diagnostic efficacy of serum APN, OPN, HE4 in endometrial cancer was analyzed by receiver operating characteristic (ROC) curve, and the correlation between serum APN, OPN, HE4 and clinicopathologic features was analyzed by Spearman correlation analysis. Results The serum levels of APN in endometrial carcinoma group were lower than those in endometrial hyperplasia group and normal endometrial group, while the levels of OPN and HE4 were higher than those in endometrial hyperplasia group and normal endometrial group. FIGO staging showed that the level of serum APN in stage Ⅲ patients was lower than those in stage Ⅱ and stage Ⅰ patients, and the levels of OPN and HE4 was higher than those in stage Ⅱ and stage Ⅰ patients. The APN level in patients with ≥ 1/2 muscle layer infiltration depth was lower than that in < 1/2 muscle layer, and the OPN and HE4 levels were higher than those in < 1/2 muscle layer. The serum APN level in patients with lymph node metastasis was lower than that in patients without lymph node metastasis, and the levels of OPN and HE4 were higher than those in patients without lymph node metastasis, with statistical significance (P < 0.05). ROC curve analysis showed that the area under the curve of serum APN, OPN and HE4 combined detection was 0.936, the sensitivity was 91.7 %, and the specificity was 88.1%, all of them were higher than those of serum APN, OPN and HE4 alone. Spearman correlation analysis showed that serum APN was negatively correlated with FIGO stage, depth of muscle infiltration and lymph node metastasis. Serum OPN and HE4 were positively correlated with FIGO stage, depth of muscle infiltration and lymph node metastasis. Conclusion Serum APN, OPN, HE4 play an important role in the occurrence and development of endometrial cancer. The expressions of APN, OPN, and HE4 are significantly correlated with the clinical staging of endometrial cancer, the depth of muscle infiltration, and lymph node metastasis, and the combined detection can improve the diagnostic efficiency of endometrial cancer.