University Hospital for Gynecology and Obstetrics, Klinikum Oldenburg AöR, Carl von Ossietzky Oldenburg University, Oldenburg, Germany.
Department of Obstetrics and Gynecology, Kosuyolu Hospital, Yeditepe University, Istanbul, Turkey.
J Obstet Gynaecol. 2021 Aug;41(6):927-932. doi: 10.1080/01443615.2020.1803245. Epub 2020 Oct 16.
Considering the complex pathogenesis of endometriosis, which is associated with many cellular or molecular processes, such as proliferation, angiogenesis, inflammation, we evaluated the diagnostic value of a quadruple panel of serum markers CA125, endocan, YKL-40 and copeptin, for the prediction of endometriosis and moderate - severe endometriosis. Seventy women with endometriosis and 70 women without endometriosis were evaluated. Serum CA125, endocan, copeptin and YKL-40 levels were significantly increased in women with endometriosis compared to the women without endometriosis and in the minimal - mild endometriosis group compared to the no-endometriosis group. YKL-40, endocan and copeptin levels were significantly increased in the moderate - severe endometriosis group compared to the mild -moderate endometriosis group but the difference in CA125 levels remained non-significant. The quadruple panel score had an AUC of 0.954, a sensitivity of 96.5% and specificity of 84.6% for prediction of moderate - severe endometriosis. Zero or one positive marker had a sensitivity of 91.4% and specificity of 88.57% to rule out endometriosis. In conclusion, a quadruple panel of serum markers-CA125, endocan, YKL-40, and copeptin may be beneficial for the diagnosis of endometriosis and especially moderate - severe endometriosis. Further studies are needed to prove the efficacy of this panel.Impact statement Many serum markers including CA125 have been investigated so far and suggested to be associated with endometriosis. However, none of these markers is sensitive and specific enough to diagnose endometriosis. A quadruple panel score (CA125, endocan, YKL-4 and copeptin) had an AUC of 0.954, a sensitivity of 96.5% and specificity of 84.6% for prediction of moderate - severe endometriosis. A high score may be beneficial to warn the surgeon about the risk of moderate to severe endometriosis if the patient will be operated anyway. A negative test of the quadruple panel may show high odds that there is no endometriosis which may prevent unnecessary surgery.
考虑到子宫内膜异位症的复杂发病机制与许多细胞或分子过程相关，如增殖、血管生成、炎症等，我们评估了血清标志物 CA125、内脂素、YKL-40 和 copeptin 的四重标志物组合对子宫内膜异位症和中重度子宫内膜异位症的预测价值。共评估了 70 名子宫内膜异位症患者和 70 名无子宫内膜异位症患者。与无子宫内膜异位症患者相比，子宫内膜异位症患者的血清 CA125、内脂素、copeptin 和 YKL-40 水平显著升高，与轻度-轻度子宫内膜异位症组相比，中重度子宫内膜异位症组的 YKL-40、内脂素和 copeptin 水平显著升高，但 CA125 水平的差异仍无统计学意义。四重标志物组合评分对中重度子宫内膜异位症的预测 AUC 为 0.954，灵敏度为 96.5%，特异性为 84.6%。零或一个阳性标志物对排除子宫内膜异位症的灵敏度为 91.4%，特异性为 88.57%。总之，CA125、内脂素、YKL-40 和 copeptin 的四重血清标志物组合可能有助于子宫内膜异位症的诊断，特别是中重度子宫内膜异位症的诊断。需要进一步的研究来验证该组合的疗效。
影响声明 迄今为止，已经研究了许多血清标志物，包括 CA125，并表明其与子宫内膜异位症相关。然而，这些标志物都没有足够的灵敏度和特异性来诊断子宫内膜异位症。四重标志物组合评分（CA125、内脂素、YKL-4 和 copeptin）对中重度子宫内膜异位症的预测 AUC 为 0.954，灵敏度为 96.5%，特异性为 84.6%。如果患者无论如何都要进行手术，高评分可能有助于提醒外科医生中重度子宫内膜异位症的风险。四重标志物的阴性检测可能表明没有子宫内膜异位症的可能性很高，这可能可以防止不必要的手术。
