妊娠女性血清CYFRA21-1和SCCA水平分析及其在妊娠期宫颈癌患者中的临床意义  

Analysis of serum CYFRA21-1 and SCCA levels in pregnant women and their clinical significance in patients with cervical cancer during pregnancy

作　　者：张倩岚 王志恒 唐慧静 张彬 沈伟虹 岳朝艳 高晶 应春妹 ZHANG Qian-lan;WANG Zhi-heng;TANG Hui-jing;ZHANG Bin;SHEN Wei-hong;YUE Chao-yan;GAO Jin;YING Chun-mei(Department of Clinical Laboratory,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院检验科,上海200011

出　　处：《复旦学报（医学版）》2024年第5期660-666,676,共8页Fudan University Journal of Medical Sciences

基　　金：上海市自然科学基金(23ZR1408100)。

摘　　要：目的分析健康孕妇孕期血清细胞角蛋白19片段抗原21-1(cytokeratin 19 fragment antigen 21-1,CYFRA21-1)和鳞状细胞癌相关抗原(squamous cell carcinoma-associated antigen,SCCA)的水平分布,并评估其对妊娠期宫颈癌的诊断价值。方法选取2021年1月至2024年5月在复旦大学附属妇产科医院就诊的441名健康妊娠女性(健康妊娠组)和69名妊娠期宫颈癌患者(肿瘤组),同期纳入复旦大学附属妇产科医院体检中心受检的165名健康女性作为健康非妊娠组。健康妊娠组女性分为孕早期(T1组)143名、孕中期(T2)147名和孕晚期(T3)151名。检测并分析各组研究对象的血清CYFRA21-1和SCCA值。采用单因素方差分析、独立样本t检验、Mann-Whitney U检验、Kruskal-Wallis H检验、Logistic回归分析及受试者操作特征ROC曲线进行比较分析。结果健康非妊娠组的CYFRA21-1和SCCA水平分别为1.66(1.19~2.17)ng/mL及0.8(0.6~1.0)ng/mL,健康妊娠组为3.07(2.11~4.14)ng/mL及0.9(0.7~1.3)ng/mL,肿瘤组为4.33(2.99~7.60)ng/mL及1.8(0.9~8.45)ng/mL,3组对象间2项指标相比差异均有统计学意义(P<0.05)。T1、T2和T3组的CYFRA21-1水平分别为3.13(2.46~4.05)ng/mL、1.89(1.50~2.53)ng/mL和4.19(3.48~5.43)ng/mL,SCCA水平分别为0.9(0.7~1.1)ng/mL、0.7(0.6~1.0)ng/mL和1.2(0.8~1.7)ng/mL,T1和T3组结果均高于健康非妊娠组(P<0.05),T2组结果与健康非妊娠组相比无明显差异(P>0.05)。妊娠期CYFRA21-1、SCCA、人附睾蛋白4、癌胚抗原及4项指标联合诊断宫颈癌的ROC曲线下面积分别为0.684、0.724、0.612、0.791和0.913,敏感度分别为36%、48%、38%、57%和73%,特异度分别为96%、97%、89%、86%和99%。各项指标的cut-off值分别为6.05 ng/mL、2.60 ng/mL、51.45 pg/mL和1.75 ng/mL。结论与非孕期健康女性相比,孕早期和孕晚期孕妇的血清CYFRA21-1和SCCA水平较高,而孕中期两项指标检测结果没有统计学差异。CYFRA21-1和SCCA对妊娠期宫颈癌有一定的诊断价值。Objective To investigate and analyze the distribution of serum cytokeratin 19 fragment antigen 21-1(CYFRA21-1)and squamous cell carcinoma-associated antigen(SCCA)levels in healthy pregnant women during pregnancy and to assess their diagnostic value for cervical cancer in pregnancy.Methods A total of 441 healthy pregnant women and 69 patients with cervical cancer in pregnancy who attended the Obstetrics and Gynecology Hospital of Fudan University from Jan 2021 to May 2024 were selected,and 165 healthy women in the Physical Examination Center of the Obstetrics and Gynecology Hospital of Fudan University were included in the same period as the control group.The healthy pregnant women were divided into 143 in early pregnancy(T1 group),147 in middle pregnancy(T2)and 151 in late pregnancy(T3).Serum CYFRA21-1 and SCCA values were detected and analyzed in all groups.Oneway ANOVA,independent samples t-test,Mann-Whitney U-test,Kruskal-Wallis H-test,logistic analysis,and ROC curves were used for comparative analysis.Results The CYFRA21-1 and SCCA values were 1.66(1.19-2.17)ng/mL and 0.8(0.6-1.0)ng/mL in the control group,3.07(2.11-4.14)ng/mL and 0.9(0.7-1.3)ng/mL in the healthy pregnant women group,and were 4.33(2.99-7.60)ng/mL and 1.8(0.9-8.5)ng/mL in the patients with cervical cancer in pregnancy group,respectively.There was a statistically significant difference in the two serum values between every two groups(P<0.05).CYFRA21-1 levels were 3.13(2.46-4.05)ng/mL,1.89(1.50-2.53)ng/mL and 4.19(3.48-5.43)ng/mL in the T1,T2,and T3 groups,respectively;and SCCA levels were 0.9(0.7-1.1)ng/mL,0.7(0.6-1.0)ng/mL and 1.2(0.8-1.7)ng/mL,respectively.The results of T1 and T3 groups were higher than those of the control group(P<0.05);however,there was no statistically significant difference between the results of the T2 group and those of the control group(P>0.05).The areas under the ROC curves for the diagnosis of cervical cancer in pregnancy for CYFRA21-1,SCCA,human epididymis protein 4(HE4),anticarcinoembryonic antigen(CEA)and joint i

关 键 词：细胞角蛋白19片段抗原21-1(CYFRA21-1) 鳞状细胞癌相关抗原(SCCA) 妊娠期宫颈癌 血清肿瘤标志物 

分 类 号：R737.33[医药卫生—肿瘤]