探讨血清癌胚抗原125(CA₁₂₅)和血浆纤维蛋白原(Fib)在卵巢良、恶性肿瘤鉴别诊断中的临床价值。

选择2015年1月至2017年6月，在成都市第二医院妇产科初次诊断和治疗的全部367例卵巢肿瘤患者为研究对象。将其中124例卵巢恶性肿瘤患者进一步分为上皮性卵巢癌和交界性卵巢肿瘤，分别纳入上皮性卵巢癌组(n＝98)和交界性卵巢肿瘤组(n＝26)，剩余243例卵巢良性肿瘤患者，则纳入对照组。采用单中心回顾性分析方法，采集所有患者初诊时血清CA₁₂₅和血浆Fib水平。采用Kruskal-Wallis H秩和检验，对3组血清CA₁₂₅水平进行比较。采用方差分析，对3组血浆Fib水平进行比较。采用χ²检验，对3组血清CA₁₂₅、血浆Fib阳性率进行比较。采用Wilcoxon秩和检验或Kruskal-Wallis H秩和检验，对不同临床病理特征的124例卵巢恶性肿瘤患者的血清CA₁₂₅水平进行比较。采用成组t检验或方差分析，对不同临床病理特征的124例卵巢恶性肿瘤患者的血浆Fib水平进行比较。了解血清CA₁₂₅与血浆Fib水平对于鉴别诊断卵巢良、恶性肿瘤的敏感度、特异度、阳性预测值和阴性预测值。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》的要求，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书。3组患者的年龄等一般临床资料比较，差异均无统计学意义(P>0.05)。

①上皮性卵巢癌组、交界性卵巢肿瘤组、对照组患者初诊时血清CA₁₂₅值分别为1 410 kU/L(255～1 650 kU/L)、138 kU/L(25～423 kU/L)、38 kU/L(0～122 kU/L)，血浆Fib值分别为(477.6±148.4)g/L、(372.8±114.1)g/L、(346.9±99.7)g/L，血清CA₁₂₅阳性率分别为86.7%(85/98)、76.9% (20/26)、40.3% (98/243)，血浆Fib阳性率分别为81.6%(80/98)、61.5%(16/26)、23.9%(58/243)。3组血清CA₁₂₅与血浆Fib水平及其阳性率分别比较，差异均有统计学意义(F＝420.511、44.73，P<0.001；χ²＝66.129、77.051，P<0.001)。②124例卵巢恶性肿瘤患者中，按照国际妇产科联盟(FIGO)进行临床分期的晚期(Ⅲ＋Ⅳ期)卵巢癌患者的血清CA₁₂₅与血浆Fib水平，均显著高于早期(Ⅰ＋Ⅱ期)卵巢癌患者，二者比较，差异均有统计学意义(Z＝7.720，P<0.001；t＝22.495，P＝0.014)。不同病理分级(高、中及低分化)与组织学类型(浆液性、黏液性、子宫内膜样及其他组织学类型)卵巢恶性肿瘤患者的血清CA₁₂₅水平分别比较，差异均有统计学意义(χ²＝14.570，P<0.001；χ²＝7.882，P＝0.004)。③血清CA₁₂₅、血浆Fib、血清CA₁₂₅联合血浆Fib、血清CA₁₂₅或血浆Fib对于鉴别诊断卵巢良、恶性肿瘤的敏感度分别为86.7%、81.6%、73.5%、89.8%，特异度分别为59.7%、76.1%、54.7%、79.0%，阳性预测值分别为46.4%、58.0%、39.6%、63.3%，阴性预测值分别为91.8%、91.1%、83.6%、95.0%。

血浆Fib水平升高是卵巢恶性肿瘤的重要预测指标，血浆Fib水平联合血清CA₁₂₅水平对于卵巢良、恶性肿瘤的鉴别诊断具有一定临床价值。

To investigate clinical values of serum carcinoembryonic antigen 125 (CA₁₂₅) and plasma fibrinogen (Fib) in differential diagnosis of benign and malignant ovarian tumors.

From January 2015 to June 2017, a total of 367 cases of ovarian tumor patients who were first diagnosed as ovarian tumor and treated in the Department of Gynecology and Obstetrics, Chengdu Second People′s Hospital were selected as research subjects. Among them, 124 cases of malignant ovarian tumor patients were divided into epithelial ovarian cancer group (n=98) and borderline ovarian tumor group (n=26), respectively. And the other 243 patients with benign ovarian tumors were enrolled into control group. A single cohort retrospective study was performed to collect levels of serum CA₁₂₅ and plasma Fib when first diagnosed as ovarian tumor. The serum CA₁₂₅ and plasma Fib levels among the 3 groups of patients were compared by Kruskal-Wallis H rank sum test and one-way ANOVA analysis, respectively. The positive rates of serum CA₁₂₅ and plasma Fib among the 3 groups were compared by chi-square test. Wilcoxon rank sum test or Kruskal-Wallis H rank sum test were used to compare serum CA₁₂₅ levels in 124 cases of malignant ovarian tumor patients with different clinicopathological features. Independent-samples t test or one-way ANOVA analysis were used to compare plasma Fib levels in 124 cases of malignant ovarian tumor patients with different clinicopathological features. To assess the values of serum CA₁₂₅ and plasma Fib levels in differential diagnosis of benign and malignant ovarian tumors by using a contingency table analysis, such as sensitivity, specificity, positive predictive value, and negative predictive value. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. All the patients themselves signed informed consents of the clinical research. There was no statistical difference in the age among the 3 groups (P>0.05).

①Among epithelial ovarian cancer group, borderline ovarian tumor group and control group, the serum CA₁₂₅ levels when first diagnosed as ovarian tumor were 1 410 kU/L (255-1 650 kU/L), 138 kU/L (25-423 kU/L), and 38 kU/L (0-122 kU/L), respectively; the plasma Fib levels were (477.6±148.4) g/L, (372.8±114.1) g/L and (346.9±99.7) g/L, respectively; the positive rates of serum CA₁₂₅ were 86.7% (85/98), 76.9% (20/26) and 40.3% (98/243), respectively; the positive rates of plasma Fib were 81.6% (80/98), 61.5% (16/26), and 23.9% (58/243), respectively. There were statistical differences in the serum CA₁₂₅ and plasma Fib levels and their positive rates among the 3 groups of patients (F=420.511, 44.73, P<0.001; χ²=66.129, 77.051, P<0.001). ②Among 124 cases of patients with malignant ovarian tumors, the serum CA₁₂₅ and plasma Fib levels of patients with advanced stage (stage Ⅲ+ Ⅳ) of malignant ovarian tumor were significantly higher than those of patients with early stage (stage Ⅰ+ Ⅱ) of malignant ovarian tumor according to the International Federation of Gynecology and Obstetrics (FIGO), and both the differences were statistically significant (Z=7.720, P<0.001; t=22.495, P=0.014). There were statistical differences in serum CA₁₂₅ levels among malignant ovarian tumor patients with different histological grades (high, moderate, and poorly differentiated) and histological types (serous, mucinous, endometrioid, and other histological types) (χ²=14.570, P<0.001; χ²=7.882, P=0.004). ③The sensitivities of serum CA₁₂₅, plasma Fib, serum CA₁₂₅ combined with plasma Fib, serum CA₁₂₅ or plasma Fib in differential diagnosis of benign and malignant ovarian tumors were 86.7%, 81.6%, 73.5% and 89.8%, respectively; and the specificities were 59.7%, 76.1%, 54.7% and 79.0%, respectively; the positive predictive values were 46.4%, 58.0%, 39.6% and 63.3%, respectively; the negative predictive values were 91.8%, 91.1%, 83.6% and 95.0%, respectively.

The increasing of plasma Fib level is an important predictor of malignant ovarian tumors. Plasma Fib level combined with serum CA₁₂₅ level has a certain clinical value in the differential diagnosis of benign and malignant ovarian tumors.