目的 探讨配对盒基因8抗体（PAX8）、α-烯醇化酶（ENO1）、人附睾蛋白4（HE4）、神经菌毛蛋白-2（NRP-2）与子宫内膜癌病情严重程度的关系及其预测患者预后情况的价值。 方法 选取康复大学青岛中心医院2021年1月至2022年11月收治子宫内膜癌患者168例，均接受手术治疗，于患者手术治疗结束后开始随访，嘱患者每间隔3个月到门诊随访1次，随访时间截止至2025年11月，失访3例，最终纳入研究165例子宫内膜癌患者作为子宫内膜癌组，中位随访时间为48个月，其中预后不良（出现病灶远处转移、患者死亡、子宫内膜癌复发等任意一项即可判断为预后不良）35例作为预后不良组，剩余130例作为预后良好组。同期选取165例良性子宫内膜疾病患者作为良性子宫内膜疾病组，165例健康女性作为健康对照组。比较各组间临床资料、血清PAX8、ENO1、HE4、NRP-2水平，不同病理特征血清PAX8、ENO1、HE4、NRP-2水平，利用Spearman相关性分析血清PAX8、ENO1、HE4、NRP-2水平与子宫内膜癌病情严重程度的关系；将预后不良组患者作为阳性病例，预后良好组患者作为阴性病例，采用受试者工作特征（ROC）曲线分析血清PAX8、ENO1、HE4、NRP-2水平对子宫内膜癌患者预后的预测价值。 结果 子宫内膜癌组血清PAX8、ENO1、HE4、NRP-2水平均高于良性子宫内膜疾病组、健康对照组，良性子宫内膜疾病组高于健康对照组（P < 0.05）。国际妇产科联盟（FIGO）分期为Ⅲ—Ⅳ期、分化程度为低分化、肌层浸润≥ 1/2、有淋巴结转移患者的血清PAX8、ENO1、HE4、NRP-2水平均高于FIGO分期为Ⅰ—Ⅱ期、分化程度为中高分化、肌层浸润< 1/2、无淋巴结转移患者（P < 0.05）。子宫内膜癌患者血清PAX8、ENO1、HE4、NRP-2水平与FIGO分期、肌层浸润、淋巴结转移均呈正相关，与分化程度则呈负相关（P < 0.05）。预后不良组患者的血清PAX8、ENO1、HE4、NRP-2水平均高于预后良好组（P < 0.05）。血清PAX8、ENO1、HE4、NRP-2水平联合检测预测子宫内膜癌患者预后的曲线下面积（AUC）高于各项单独检测（P < 0.05）。 结论 血清PAX8、ENO1、HE4、NRP-2水平在子宫内膜癌患者中呈现异常表达，与其病情严重程度关系密切，且联合检查预测子宫内膜癌患者预后具有较高的临床价值。

Objective To explore the relationships among Paired box 8 （PAX8）， α-enolase （ENO1）， human epididymal protein 4 （HE4）， and neuropilin-2 （NRP-2）， as well as their associations with the severity of endometrial cancer and their value in predicting the prognosis of patients. Methods From January 2021 to November 2022， 168 patients diagnosed with endometrial cancer were recruited， all of whom underwent surgical treatment. Following the surgical intervention， a follow-up protocol was initiated， requiring patients to attend follow-up appointments every three months. The follow-up period extended until November 2025. During this period， 3 patients were lost to follow-up. Ultimately， 165 patients with endometrial cancer were included in the study， forming the endometrial cancer group， with a median follow-up duration of 48 months. Among these patients， 35 cases with a poor prognosis （poor prognosis was defined as any occurrence of distant metastasis， patient death， or recurrence of endometrial cancer） were classified as the poor prognosis group， while the remaining 130 cases were designated as the good prognosis group. Concurrently， 165 patients with benign endometrial diseases were selected as the benign endometrial diseases group， and 165 healthy women were recruited as the healthy control group. Clinical data and serum levels of PAX8， ENO1， HE4， and NRP-2 were compared across the groups. The serum levels of PAX8， ENO1， HE4， and NRP-2 in relation to different pathological features were analyzed. The relationship between the serum levels of PAX8， ENO1， HE4， and NRP-2 and the severity of endometrial cancer was examined using Spearman correlation analysis. By designating patients with a poor prognosis as positive cases and those with a good prognosis as negative cases， the predictive value of the serum levels of PAX8， ENO1， HE4， and NRP-2 for the prognosis of patients with endometrial cancer was evaluated using the receiver's operating characteristics （ROC） curve. Results The serum levels of PAX8， ENO1， HE4， and NRP-2 in the endometrial cancer group were significantly higher than those in the benign endometrial disease group and the healthy control group. Additionally， the levels in the benign endometrial disease group were significantly higher than those in the healthy control group （P < 0.05）. In patients， the levels of serum PAX8， ENO1， HE4， and NRP-2 in those with FIGO stage Ⅲ-Ⅳ， poor differentiation， myometrial infiltration ≥ 1/2， and lymph node metastasis were significantly higher than those in patients with FIGO stage Ⅰ-Ⅱ， medium-high differentiation， myometrial infiltration < 1/2， and no lymph node metastasis （P < 0.05）. The serum levels of PAX8， ENO1， HE4， and NRP-2 were positively correlated with FIGO stage， myometrial infiltration， and lymph node metastasis， while negatively correlated with differentiation （P < 0.05）. The serum levels of PAX8， ENO1， HE4， and NRP-2 in patients with a poor prognosis were significantly higher than those in patients with a good prognosis （P < 0.05）. The combined detection of the serum levels of PAX8， ENO1， HE4， and NRP-2 could predict the area under the curve （AUC） of endometrial cancer patients， and this AUC value was higher than that of individual detection （P < 0.05）. Conclusions Serum levels of PAX8， ENO1， HE4， and NRP-2 are abnormally expressed in patients with endometrial cancer. This abnormal expression is closely related to the severity of the disease. Moreover， the combined examination of these markers has high clinical value in predicting the prognosis of patients with endometrial cancer.