Yang Qian, Niu Yan, Zhou Qianghua, Yang Dan-Ni, Zhu Hong-Zhe, Yan Cheng, Cha Su-Na, Jiang Ting-Wang, Yan Li, Zheng Wen-Qi, Wen Jian-Xun, Hu Zhi-De
Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
Key Laboratory for Biomarkers, Inner Mongolia Medical University, Hohhot, China.
Sci Rep. 2025 Jan 25;15(1):3217. doi: 10.1038/s41598-025-86929-5.
Previous studies have suggested that the presence of human epididymal protein 4 (HE4) in pleural fluid can be used to diagnose malignant pleural effusion (MPE) with moderate accuracy. However, the factors that affect the diagnostic accuracy of HE4 remain unknown. This study aimed to examine how age and sex influence the diagnostic accuracy of HE4. Participants with undiagnosed pleural effusion were prospectively enrolled in two cohorts (Hohhot cohort and Changshu cohort), and the presence of HE4 in their pleural fluid upon admission was determined by an electrochemiluminescence immunoassay. A receiver operating characteristic (ROC) curve with its area under the curve (AUC) was utilized to assess the diagnostic value of HE4 for MPE. Additionally, we conducted subgroup analyses and used a resampling method with different upper age limits to investigate the impacts of age and sex on the diagnostic accuracy of HE4 for MPE. The Hohhot cohort included 86 patients with benign pleural effusions (BPEs) and 66 patients with MPE, whereas the Changshu cohort included 26 patients with MPE and 32 patients with BPE. The diagnostic accuracy of HE4 decreased as age increased in both cohorts. The diagnostic accuracy of HE4 in males did not differ significantly from that in females. Therefore, we conclude that age should be considered when using HE4 in pleural fluid to diagnose MPE.
以往研究表明，胸腔积液中人类附睾蛋白4（HE4）的存在可用于以中等准确性诊断恶性胸腔积液（MPE）。然而，影响HE4诊断准确性的因素仍不清楚。本研究旨在探讨年龄和性别如何影响HE4的诊断准确性。将未确诊胸腔积液的参与者前瞻性纳入两个队列（呼和浩特队列和常熟队列），入院时通过电化学发光免疫分析法测定其胸腔积液中HE4的存在情况。利用受试者工作特征（ROC）曲线及其曲线下面积（AUC）评估HE4对MPE的诊断价值。此外，我们进行了亚组分析，并使用不同年龄上限的重采样方法来研究年龄和性别对HE4诊断MPE准确性的影响。呼和浩特队列包括86例良性胸腔积液（BPE）患者和66例MPE患者，而常熟队列包括26例MPE患者和32例BPE患者。在两个队列中，HE4的诊断准确性均随年龄增长而降低。HE4在男性中的诊断准确性与女性相比无显著差异。因此，我们得出结论，在使用胸腔积液中的HE4诊断MPE时应考虑年龄因素。
