目的：探讨血清人附睾蛋白4(HE4)在子宫内膜癌患者中的表达情况以及与临床特点和病理学特征的关系。方法采用ELISA法检测并比较266例子宫内膜癌患者、204例子宫良性疾病患者及100例健康女性血清中HE4的表达差异,分析血清HE4与子宫内膜癌患者年龄、月经状态、病理学类型、组织学分级、淋巴结转移、肌层浸润深度、国际妇产科联盟( FIGO)分期以及疗效的相关性。结果研究组266例子宫内膜癌患者血清HE4的表达水平为85.63(60.98~125.78)pmol/L,明显高于正常对照组56.05(50.30~63.50)pmol/L(Z=-8.257,P<0.001)及对照组的59.52(50.11~71.09)pmol/L(Z=-8.865,P<0.001)；而在正常对照组与对照组之间,血清HE4的表达比较差异并无统计学意义(Z=-1.458,P>0.05)。研究组中,血清HE4水平在不同患者年龄、月经状态、组织学分级、淋巴结转移、肌层浸润深度以及FIGO分期等方面比较,差异均有统计学意义( Z值分别为-3.849、-3.099、-5.279、-7.763、-5.704、-5.855,均P<0.01)；而在肿瘤的组织病理学类型方面比较差异无统计学意义(Z=5.086,P>0.05)。有198例子宫内膜癌患者术前的血清HE4水平为87.24(62.65~129.95)pmol/L,显著高于术后血清HE4水平65.38(51.58~82.01)pmol/L,差异有统计学意义(Z=-7.833,P<0.001)。结论血清HE4水平在子宫内膜癌患者中高表达,且与年龄、月经状态、组织学分级、淋巴结转移、肌层浸润深度、FIGO分期及疗效相关,提示血清HE4可以作为子宫内膜癌临床诊断、疗效评价、预后判断及随访监测的分子标记物。%Objective To investigate the expression of serum human epididymis protein 4 ( HE4 ) in endometrial cancer patients and its relationship with clinical and pathological characteristics. Methods The serum HE4 levels were detected by Enzyme linked immunosorbent assay ( ELISA) and compared among 100 healthy women, 204 patients with benign uterus diseases of uterus and 266 patients with histologically confirmed endometrial carcinoma. The correlation between expression of serum HE4 and clinicpathological characteristics ( age, menstruation status, histopathology, tumor grade, lymph node metastasis, depth of myometrial invasion, FIGO stage ) and therapeutic effect was also evaluated. Results The concentration of serum HE4 was 85. 63 (60. 98 -125. 78) pmol/L in patients with endometrial cancer, which was significantly higher than that in healthy women[56. 05 (50. 30-63. 50)pmol/L, Z= -8. 257,P<0. 001] and benign lesion group[59. 52 (50. 11 -71. 09) pmol/L, Z = -8. 865, P <0. 001], but the difference was not significant between healthy group and benign lesion group (Z= -1. 458,P>0. 05). In endometrial cancer group, the expression of serum HE4 was not associated with the type of histopathology (Z=5. 086, P>0. 05), but it was positively correlated with age, menstruation status, tumor grade, lymph node metastasis, depth of myometrial invasion and FIGO stage ( Z value was -3. 849, -3. 099, -5. 279, -7. 763,-5. 704 and -5. 855, respectively, all P<0. 01). Furthermore, the postoperative level of serum HE4 [65. 38 (51. 58-82. 01)] in 198 cases of endometrial cancer was significantly lower than preoperative level [87. 24 (62. 65-129. 95)] (Z= -7. 833,P<0. 001). Conclusion The serum HE4 is over-expressed in endometrial carcinoma, and its concentration significantly correlates with age, menstruation status, histological grade, lymph node metastasis, depth of myometrial invasion, FIGO stage and treatment effect, which indicates that serum HE4 may serve as a biomarker for endometrial carcinoma and has significant application in diagnosis, therapeutic evaluation, prognostic prediction and postoperative surveillance.
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