摘要
目的探讨胰腺癌患者血清和尿液人软骨糖蛋白-39(YKL-40)表达水平及其诊断和预后评估的价值。方法选择2014年7月至2017年7月在湖北省荆门市妇幼保健院和荆门市第二人民医院58例胰腺癌患者作为胰腺癌组,50例健康人群作为对照组,采用酶联免疫吸附试验检测两组血清和尿液YKL-40浓度,采用受试者工作特征曲线评价血清YKL-40对胰腺癌的诊断效能。按照血清和尿液YKL-40浓度将胰腺癌患者分为YKL-40低浓度组和高浓度组。χ2检验分析YKL-40水平与胰腺癌患者临床资料的关系,Kaplan-Meier法评估两组患者中位生存期的差异;单因素和多因素Cox比例风险回归模型分析影响胰腺癌不良预后的影响因素。结果胰腺癌组血清YKL-40浓度明显高于对照组[(117.16±46.78)ng/ml比(68.88±12.37)ng/ml],差异有统计学意义(P<0.05)。血清YKL-40诊断胰腺癌的曲线下面积(AUC)为0.839(95%CI 0.755~0.902),特异度为67.2%,敏感度为98.0%。血清YKL-40水平与年龄、分化程度、血管侵犯、TNM分期、切缘情况有关,尿液YKL-40水平与血管侵犯、TNM分期、切缘情况有关(均P<0.05)。血清和尿液YKL-40高浓度组生存时间较低浓度组明显缩短(P<0.05)。YKL-40浓度升高(HR:3.696,95%CI 1.680~8.130,P=0.001)、尿液YKL-40浓度升高(HR:2.846,95%CI 1.311~6.178,P=0.008)、有血管侵犯(HR:0.308,95%CI 0.146~0.651,P=0.002)、高肿瘤TNM分期(HR:1.997,95%CI 1.005~3.967,P=0.048)是胰腺癌不良预后的独立预后因素。结论血清YKL-40可以作为胰腺癌诊断指标,血清和尿液YKL-40浓度均可以作为胰腺癌预后判断的指标。尿液YKL-40检测具有无创操作优点,其在预后判断中的价值更高。
Objective To explore the prognostic and diagnositic value of serum and urine humancartilage-glycoprotein-39(YKL-40)in patients with pancreatic cancer.Methods A total of 58 pancreatic cancer patients and 50 healthy controls were enrolled as pancreatic cancer group and control group in the Maternity and Child health Care Center of Jingmen and the Second People′s Hospital of Jingmen from July 2014 to July 2017.The levels of serum and urine YKL-40 were detected by ELISA assay.The diagnostic efficiency of serum YKL-40 was determined by receiver operating characteristic.According to the serum,urine YKL-40 concentrations,pancreatic cancer patients were divided into two groups:the YKL-40 high group and the YKL-40 low group.The correlation between YKL-40 levels and clinical characteristics was analyzed byχ2 test.Median survival was calculated by Kaplan-Meier method.The risk factors of patients with poor prognosis were analyzed by univariate and multivariate Cox regression analysis model.Results The levels of serum YKL-40 were significantly increased in the pancreatic cancer group compared to those of the control group[(117.16±46.78)ng/ml vs.(68.88±12.37)ng/ml](P<0.05).The area under ROC curve(AUC)of serum YKL-40 for the diagnosis of pancreatic cancer were 0.839(95%CI 0.755-0.902),with a sensitivity and specificity of 67.2%and 98.0%,respectively.Age,differentiation,vascular invasion,tumor TNM,positive surgical margin stage had significant relationship with serum YKL-40 level,and vascular invasion,tumor TNM,positive surgical margin stage had significant relationship with urine YKL-40 level(all P<0.05).Compared with lower YKL-40 group,the median survival of higher YKL-40 group decreased remarkablely,and the difference was statistically(all P<0.05).A high serum YKL-40 level(HR:3.696,95%CI 1.680-8.130,P=0.001),high urine YKL-40 level(HR:2.846,95%CI 1.311-6.178,P=0.008),vascular invasion(HR:0.308,95%CI 0.146-0.651,P=0.002),high tumor TNM(HR:1.997,95%CI 1.005-3.967,P=0.048)was identified as an independent risk factor of poor prognosis for patients with pancreatic cancer(all P<0.05).Conclusions Serum YKL-40 can be used as a diagnostic marker for pancreatic cancer,and both serum and urine YKL-40 can be served as prognostic marker for pancreatic cancer.However,urine YKL-40 has a better clinical value for this index with advantages of non-invasive operation.
作者
王治华
刘莉
向健
王俊
Wang Zhihua;Liu Li;Xiang Jian;Wang Jun(Department of Laboratory,Maternity and Child Health Care Center of Jingmen,Hubei Jingmen 448000,China;Department of Laboratory,the Second People′s Hospital of Jingmen,Hubei Jingmen 448000,China;Department of Blood Transfusion,the First People′s Hospital of Tianmen,Hubei Tianmen 431700,China;Department of Laboratory,the First People′s Hospital of Tianmen,Hubei Tianmen 431700,China)
出处
《中国医师进修杂志》
2019年第12期1112-1117,共6页
Chinese Journal of Postgraduates of Medicine
关键词
胰腺肿瘤
诊断
预后
人软骨糖蛋白-39
Pancreatic neoplasms
Diagnosis
Prognosis
Humancartilage-glycoprotein-39
作者简介
通信作者:刘莉,Email:819619980@qq.com,电话:0724-6903032。
