肺癌患者血清多效蛋白表达水平及其临床意义

doi:10.3877/cma.j.issn.1674-6902.2017.03.010

目的

探讨血清多效蛋白(PTN)在肺癌患者中的表达及其临床意义。

方法

采用ELISA检测57例非小细胞肺癌(NSCLC)患者、20例小细胞肺癌(SCLC)患者和12例正常对照组血清PIN水平，分析其对肺癌的诊断价值及与NSCLC病理分期和手术的关系。

结果

正常对照组PTN水平明显低于SCLC组(P<0.001)和NSCLC组(P＝0.003)，并且SCLC组PTN水平显著高于NSCLC组(P＝0.010)。ROC曲线分析PTN对肺癌诊断的AUC为0.821(95%CI 0.730～0.913)(P<0.001)；对NSCLC诊断的AUC为0.794(95%CI 0.684～0.904)(P＝0.001)；对SCLC诊断的AUC为0.900(95%CI 0.783～1.000)(P<0.001)。NSCLC患者PTN水平与病理分期(P<0.001)和肿瘤远处转移(P＝0.019)密切相关，与病理类型和淋巴结转移无关(P>0.05)。NSCLC患者手术后PTN水平较手术前明显降低(P<0.001)。

结论

血清PTN可作为诊断肺癌的指标，PTN还可用于NSCLC病情监测和疗效判断。

关键词: 多效蛋白, 支气管肺癌, 诊断, 临床意义

Objective

To investigate the serum levels and clinical significance of the angiogenic factor pleiotrophin (PTN) in patients with lung cancer.

Methods

Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of PTN in 57 patients with non-small cell lung cancer (NSCLC), 20 patients with small cell lung cancer (SCLC) and 12 healthy individuals, and their relationship with pathological stage and operation therapy foe NSCLC was explored.

Results

PTN expression was significantly lower in healthy individuals than that in SCLC (P<0.001) and NSCLC patients (P=0.003). PTN level was significantly higher in SCLC patients than that in NSCLC patients (P=0.010). High expression of PTN was identified as a moderately specific marker for lung carcinoma distinguished from healthy subjects with the area under the ROC curve (AUC) at 0.821(95%CI 0.730~0.913) (P<0.001). Additionally, PTN was identified as a lowly specific marker for NSCLC distinguished from healthy subjects with AUC at 0.794 (95%CI 0.684~0.904) (P=0.001). However, PTN was identified as a highly specific marker for SCLC distinguished from healthy subjects with AUC at 0.900 (95%CI 0.783~1.000) (P<0.001). The PTN level in NSCLC patients was significantly associated with clinical stage (P<0.001) and distant metastasis (P=0.019). No association was found between PTN and other clinic pathological features such as pathological type and lymphatic metastasis in NSCLC patients. Compared with NSCLC patients before opertion, PTN level in NSCLC patients after operation was significantly decreased(P<0.001).

Conclusion

PTN in serum has the important values of diagnosing lung cancer. Moreover, PTN in serum can be available to estimate condition and curative effects of NSCLC.

Key words: Pleiotrophin, Bronchiogenic lung cancer, Diagnosis, Clinical significance

图1 肺癌患者和正常对照血清PTN水平柱状图

图2 血清PTN诊断肺癌的ROC曲线图；注：A:血清PTN诊断肺癌的ROC曲线图和AUC；B：血清PTN诊断NSCLC的ROC曲线图和AUC；C：血清PTN诊断SCLC的ROC曲线图和AUC。

表1 NSCLC患者PTN水平与临床参数间的关系(±s)

临床资料		例数	PTN(μg/L)	P值^ab
病理类型		?	?	0.848
?	肺腺癌	35	35.41±12.38	?
?	肺鳞癌	22	31.92±12.65	?
病理分期		?	?	0.000
?	Ⅰ期	11	21.59±9.14	?
?	Ⅱ期	25	30.34±12.73	?
?	Ⅲ期	14	42.32±6.18	?
?	Ⅳ期	7	42.94±7.36	?
淋巴结转移		?	?	0.368
?	无	12	29.34±9.10	?
?	有	45	35.20±13.00	?
远处转移		?	?	0.019
?	无	50	32.22±13.15	?
?	有	7	40.97±6.07	?

表1 NSCLC患者PTN水平与临床参数间的关系(±s)

临床资料		例数	PTN(μg/L)	P值^ab
病理类型		?	?	0.848
?	肺腺癌	35	35.41±12.38	?
?	肺鳞癌	22	31.92±12.65	?
病理分期		?	?	0.000
?	Ⅰ期	11	21.59±9.14	?
?	Ⅱ期	25	30.34±12.73	?
?	Ⅲ期	14	42.32±6.18	?
?	Ⅳ期	7	42.94±7.36	?
淋巴结转移		?	?	0.368
?	无	12	29.34±9.10	?
?	有	45	35.20±13.00	?
远处转移		?	?	0.019
?	无	50	32.22±13.15	?
?	有	7	40.97±6.07	?

表2 手术前后血清PTN水平变化(±s)

组　别	例数	PTN(μg/L)
手术前	48	34.07±12.49
手术后	48	28.58±8.78^a
t值	?	－7.004
P值	?	0.000

表2 手术前后血清PTN水平变化(±s)

组　别	例数	PTN(μg/L)
手术前	48	34.07±12.49
手术后	48	28.58±8.78^a
t值	?	－7.004
P值	?	0.000

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Expression of pleiotrophin in serum and its clinical significance in patients with lung cancer

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Expression of pleiotrophin in serum and its clinical significance in patients with lung cancer