外周血人端粒酶反转录酶mRNA及四种肿瘤标志物检测在胃癌诊断中的价值  

Diagnostic value of detection of peripheral blood human telomerase reverse transcriptase mRNA and four tumor markers in patients with gastric cancer

作　　者：丽敏 孙鲁山[2] 冯长梅[2] 宋佳春 Li Min;Sun Lus han;Feng Chungmei;Song Jiachun(Department of Graduate School. Baotou Medical College, Baotou 014040, China;Department of Clinical lAiboraiory. the Third Affiliated Hospital of Baotou Medical College, Baotou 014030, China;Department of Clinical Laboratory, the Fourth Hospital of Baotou, Baotou 014030. China;Department of Clinical Laboratory, Baotou Tumor Hospital, Baotou 014030, China)

机构地区：[1]包头医学院研究生学院,014040 [2]包头医学院第三附属医院检验科,014030 [3]包头市第四医院检验科,014030 [4]包头市肿瘤医院检验科,014030

出　　处：《肿瘤研究与临床》2019年第4期245-249,共5页Cancer Research and Clinic

基　　金：包头市社会发展科技支撑项目(2012S2006-14).

摘　　要：目的探讨外周血人端粒酶反转录酶(hTERT)mRNA与肿瘤标志物癌胚抗原(CEA)、糖类抗原72-4(CA72-4)、CA19-9、CA125单项、联合检测在胃癌诊断中的应用价值。方法收集包头市肿瘤医院2017年6月至2018年10月初次诊断为胃癌的48例患者为试验组,同期50名健康体检者为健康对照组,全部受试者采集外周静脉血标本。反转录合成hTERT cDNA后,应用实时荧光定量聚合酶链反应(RT-PCR)扩增hTERT基因段。电化学发光法检测CEA、CA72-4、CA19-9、CA125。计算各个标志物单项或联合检测的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比及阴性似然比。对联合检测项目进行灵敏度及特异度的比较。结果外周血hTERT mRNA(P<0.01)、CEA(P=0.002)、CA72-4(P=0.003)、CA19-9(P=0.017)在胃癌组与健康对照组中的阳性率比较差异有统计学意义,而CA125阳性率在两组中差异无统计学意义(P>0.05)。hTERT mRNA表达与TMN分期、淋巴结转移及远处转移有关(均P<0.05),与年龄、性别、发生部位、浸润程度、分化程度无关(均P>0.05)。诊断指标计算结果显示,hTERT mRNA有较高灵敏度(84.8%)、特异度(82.7%)、准确度(83.7%)、阳性预测值(81.2%)、阳性似然比(4.90);CA72-4对胃癌诊断效果仅次于hTERT mRNA,其特异度(61.2%)、准确度(64.3%)、阳性预测值(45.8%)均较高。CA125、CEA、CA72-4、CA19-9、hTERT mRNA联合检测与hTERT mRNA、CEA、CA72-4、CA19-9联合检测的诊断性能相比,差异无统计学意义(P>0.05)。传统肿瘤标志物CEA、CA72-4、CA19-9联合检测时灵敏度为62.5%、特异度为80.0%,hTERT mRNA、CEA、CA72-4、CA19-9联合检测的灵敏度可提高至90.0%,特异度降低至67.5%,两种联合检测组合灵敏度改变差异有统计学意义(P=0.019),特异度改变差异无统计学意义(P>0.05)。结论外周血hTERT mRNA综合评价指标优于传统胃癌标志物,有望成为诊断胃癌的一种新型标志物。Objective To evaluation the value of single and combined detection of peripheral blood human telomerase reverse transcriptase (hTERT) mRNA and tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 72-4 (CA72-4), CA19-9 and CA125 in the diagnosis of gastric cancer. Methods A total of 48 patients diagnosed with gastric cancer from June 2017 to October 2018 in Baotou Tumor Hospital were enrolled in the study group. Fifty healthy subjects were selected as healthy control group. The peripheral venous blood samples were collected from all subjects. After the synthesis of hTERT cDNA by reverse transcription, real-time fluorescence quantitative polymerase chain reaction (RT-PCR) was used for the amplification of hTERT gene fragment. The tumor markers CEA, CA72-4, CA19-9 and CA125 were quantitatively detected by electrochemiluminescence instrument. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of individual markers or joint detection were calculated. The sensitivity and specificity of joint testing items were compared. Results There were statistically significant differences in the positive rates of hTERT mRNA (P < 0.01), CEA (P = 0.002), CA72-4 (P = 0.003), and CA19-9 (P = 0.017) between the gastric cancer group and the healthy control group, while the positive rates of CA125 were not significantly different between the two groups (P > 0.05). The expression of hTERT mRNA was correlated with TMN stage, lymph node metastasis and distant metastasis (all P < 0.05), but was not correlated with age, sex, tumor location, invasion degree and differentiation degree (all P > 0.05). The results of diagnostic indices showed that the hTERT mRNA had high sensitivity (84.8%), specificity (82.7%), accuracy (83.7%), positive predictive value (81.2%) and positive likelihood ratio (4.90). CA72-4 also had high specificity (61.2%), accuracy (64.3%), and positive predictive value (45.8%), which were second only to the hTERT mRNA. The dia

关 键 词：胃肿瘤 诊断 端粒酶反转录酶 肿瘤标记 生物学 聚合酶链反应 

分 类 号：R735.2[医药卫生—肿瘤]