【摘要】：目的 通過檢測子宮腺肌病患者血清HE4、CA125的含量及組織中HE4的表達(dá)，探討HE4與子宮腺肌病的相關(guān)性。 方法 采用ELISA法檢測濟南軍區(qū)總醫(yī)院婦科收住院的40例子宮腺肌病患者（術(shù)后病理證實為子宮腺肌病，排除合并子宮內(nèi)膜異位癥、子宮肌瘤及其他惡性腫瘤）術(shù)前血清HE4、CA125的含量，隨機選取28例門診健康體檢婦女作為對照；采用SP法檢測相對應(yīng)的40例子宮腺肌病組織中HE4的表達(dá)，24例正常子宮內(nèi)膜組織作為對照。 結(jié)果 1.子宮腺肌病患者血清HE4、CA125的含量分別為39.67±13.56pmol/L和150.57±124.51U/ml，均顯著高于健康對照組20.08±5.94pmol/L和10.75±7.10U/ml，差異有統(tǒng)計學(xué)意義（t＝7.166，P＝0.000；t＝5.922，P＝0.000）；且二者的表達(dá)水平呈線性相關(guān)（r＝0.411，P＝0.008）。 2.子宮腺肌病組以健康組為參照，ROC曲線下面積為0.909，標(biāo)準(zhǔn)誤為0.037，95%置信區(qū)間（0.840，，0.978），當(dāng)血清HE4的最佳診斷界值點（cut off值）為31.035pmol/L時，靈敏度為0.825，特異度為0.964，診斷指數(shù)最高為0.789，此時診斷價值較高。 3.HE4在腺肌病異位病灶組織中多為強陽性表達(dá)，陽性表達(dá)率為72.50%，顯著高于在位內(nèi)膜組（47.50%）和正常子宮內(nèi)膜組（45.83%），差異有統(tǒng)計學(xué)意義（x2＝5.208，P＝0.022；x2＝4.551，P＝0.033）；但HE4在在位內(nèi)膜組與正常子宮內(nèi)膜組比較無差異（x2＝0.017，P＝0.897）。 4.彌漫型腺肌病組血清及組織中HE4的表達(dá)顯著高于局限型組，差異有統(tǒng)計學(xué)意義（P=0.042），在腺肌病不同月經(jīng)周期及不同子宮大小分組中的表達(dá)無差異（P=1.000，P=0.147），且血清與組織中HE4的表達(dá)水平呈線性相關(guān)（r＝0.386，P＝0.014）。 結(jié)論 1.子宮腺肌病患者血清與組織中HE4的表達(dá)明顯升高，且二者的表達(dá)呈線性相關(guān)，尤其是在彌散型腺肌病組中的表達(dá)最高，提示HE4可能增強了異位內(nèi)膜細(xì)胞向肌層的侵襲、浸潤能力，可能促進子宮腺肌病的發(fā)生和發(fā)展。 2.子宮腺肌病患者血清HE4的含量最高為83.07pmol/L；ROC曲線下面積為0.909，以31.035pmol/L作為診斷臨界值時，特異度為96.4%，靈敏度為82.5%，提示HE4對子宮腺肌病的診斷及鑒別診斷具有一定作用。
[Abstract]:Objective to investigate the correlation between HE4 and adenomyosis by detecting the content of serum HE4,CA125 and the expression of HE4 in the tissues of patients with adenomyosis. Methods ELISA method was used to detect serum HE4, before operation in 40 patients with adenomyosis (confirmed by pathology after operation, excluding endometriosis, uterine leiomyoma and other malignant tumors) in gynecological department of Jinan military region General Hospital. CA125 content, 28 healthy women were randomly selected as control group. SP method was used to detect the expression of HE4 in 40 cases of adenomyosis and 24 cases of normal endometrium as control. Result 1. The serum HE4,CA125 levels in patients with adenomyosis were 39.67 鹵13.56pmol/L and 150.57 鹵124.51 U / ml, respectively, which were significantly higher than those in the healthy control group (20.08 鹵5.94pmol/L and 10.75 鹵7.10 U / ml). P0. 000; There was a linear correlation between the two expression levels (r = 0.411P ~ (0.000), and a linear correlation was found between the two expression levels (r ~ (0.411) P ~ (+) ~ (0.008). 2. In the adenomyosis group, the area under the ROC curve was 0.909, and the standard error was 0.037% confidence interval (0.840 鹵0.978). When the best diagnostic threshold for serum HE4 was 31.035pmol/L, the area under the ROC curve was 0.909, and the standard error was 0.037% confidence interval (0.840 鹵0.978). The sensitivity was 0.825, the specificity was 0.964, the highest diagnostic index was 0.789, and the diagnostic value was higher. The positive expression rate of 3.HE4 in ectopic lesions of adenomyosis was 72.50%, which was significantly higher than that in eutopic endometrium (47.50%) and normal endometrium (45.83%). The difference was statistically significant (x2 + 5.208). There was no significant difference in HE4 between eutopic endometrium group and normal endometrium group (x 2 0. 017 P < 0. 097), but there was no significant difference in HE4 between eutopic endometrium group and normal endometrium group (x 2 0. 017 P < 0. 097). 4. The expression of HE4 in serum and tissues of diffuse adenomyosis group was significantly higher than that in localized type group (P0. 042). There was no difference in the expression of HE4 in different menstrual cycle and different uterine size groups of adenomyosis (P0. 000 P0. 147). There was a linear correlation between the expression of HE4 in serum and tissue (r = 0.386 P0. 014). Conclusion 1. The expression of HE4 in serum and tissue was significantly increased in patients with adenomyosis, and the expression of HE4 was linearly correlated, especially in the diffuse adenomyosis group, suggesting that HE4 might enhance the invasion of ectopic endometrial cells to the myometrium. Infiltration ability may promote the occurrence and development of adenomyosis. 2. The highest level of serum HE4 was 83.07 pmol / L in patients with adenomyosis. The area under the ROC curve was 0.909. When 31.035pmol/L was used as the diagnostic critical value, the specificity was 96.4 and the sensitivity was 82.5, which suggested that HE4 had a certain role in the diagnosis and differential diagnosis of adenomyosis.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.71

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