Panel of markers can accurately predict endometriosis in a subset of patients
Panel of markers can accurately predict endometriosis in a subset of patients
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DOI：
10.1016/j.fertnstert.2007.05.014
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发表时间：
2008-05-01
影响因子：
6.7
通讯作者：
Barnhart, Kurt T.
中科院分区：
文献类型：
--
作者：
Seeber, Beata;Sammel, Mary D.;Barnhart, Kurt T.
目的：评估炎症和CA-125的假定标记物的组合是否可以作为异质性患者人群中子宫内膜异位症的多标记物筛查试验。设计：诊断试验的病例对照评价。设置：大学医学中心。患者：对因疼痛、不孕症、选择性输卵管结扎、输卵管再吻合术而接受腹腔镜检查的育龄妇女进行指导，或其他良性适应症。干预措施：诊断性腹腔镜检查和外周静脉穿刺。主要结果测量：使用ELISA测定法测量白细胞介素-6、肿瘤坏死因子-α、巨噬细胞移动抑制因子、巨噬细胞趋化蛋白-1、干扰素-γ、瘦素和CA-125的血清浓度;子宫内膜异位症的手术分期。结果：比较了63名经手术证实患有II-IV期子宫内膜异位症的女性和78名经手术证实没有子宫内膜异位症的女性之间的七种标志物浓度。基于受试者工作特征曲线，每个标记物的个体诊断性能较差。当使用分类树分析评估标记物的组合时，CA-125、巨噬细胞趋化蛋白-1和瘦素的三个标记物组可以诊断51%的受试者存在子宫内膜异位症，准确率为89%。CA-125、巨噬细胞趋化蛋白-1、瘦素和巨噬细胞移动抑制因子的四种标记物可以诊断48%的受试者，准确率为93%。其余受试者将没有明确的诊断算法的基础上，将需要进行标准evaluation. Conclusions（S）：这项大型研究评估合并使用推定的血清标志物诊断子宫内膜异位症，而不是使用每个单独。在两层决策规则中使用四种标志物的血清浓度，该人群中近一半的受试者将被诊断（并且可以避免手术），准确率为93%。
Objective: To evaluate whether a combination of putative markers of inflammation and CA-125 could serve as a multiple-marker screening test for endometriosis in a heterogeneous population of patients.Design: Case-control evaluation of a diagnostic test.Setting: University medical center.Patient(s): Consenting women of reproductive age undergoing laparoscopy for indications of pain, infertility, elective tubal ligation, tubal reanastomosis, or other benign indications.Intervention(s): Diagnostic laparoscopy and peripheral venipuncture.Main Outcome Measure(s): Serum concentrations of interleukin-6, tumor necrosis factor-alpha, macrophage migration inhibitory factor, macrophage chemotactic protein-1, interferon-gamma, leptin, and CA-125 measured by using ELISA assays; surgical staging of endometriosis.Result(s): Concentrations of the seven markers were compared between the 63 women with surgically confirmed stage II-IV endometriosis and 78 women who were surgically confirmed to be free of endometriosis. The individual diagnostic performance of each of the markers, based on receiver operating characteristic curves, was poor. When combinations of markers were evaluated by using classification tree analysis, a three-marker panel of CA-125, macrophage chemotactic protein-1, and leptin could diagnose 51% of subjects as to the presence of endometriosis with 89% accuracy. A four-marker panel of CA-125, macrophage chemotactic protein-1, leptin, and macrophage migration inhibitory factor could diagnose 48% of subjects with 93% accuracy. The remaining subjects would have no definitive diagnosis on the basis of the algorithm and would need to undergo standard evaluation.Conclusion(s): This large study evaluates the combined use of putative serum markers for the diagnosis of endometriosis, rather than the use of each singly. Using the serum concentration of four markers in a two-tiered decision rule, nearly half of the subjects in this population would have been diagnosed (and could have avoided surgery) with 93% accuracy.