七项肿瘤相关自身抗体检测联用在非小细胞肺癌辅助诊断中的临床价值  

The clinical application value of seven tumor-associated autoantibodies in the diagnosis of non-small cell lung cancer

作　　者：陆柳[1] 丁梦蕾[1] 成宇 郭一德 王科力 范列英[1] Lu Liu;Ding Menglei;Cheng Yu;Guo Yide;Wang Keli;Fan Lieying(Department of Clinical Laboratory,Shanghai Dongfang Hospital Affiliated Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院临床检验科,上海200120

出　　处：《中华检验医学杂志》2019年第9期768-775,共8页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨联用7项肿瘤相关自身抗体(7-tumor associatedauto antibodies,7-TAAB)检测辅助诊断非小细胞肺癌(NSCLC)的临床应用价值。方法本研究为横断面研究。收集2017年2月至2018年6月在同济大学附属东方医院就诊的81例NSCLC初诊患者作为NSCLC组,同时选择肺部良性疾病患者46例及体检健康对象55名分别作为疾病对照组(BLD)和健康对照组(HC),采用ELISA方法检测p53、PGP9.5、SOX2、GAGE7、GBU4-5、MAGEA1和CAGE的7项TAAB在肿瘤组与对照组血清中的浓度。同时检测所有入组对象血清肺癌肿瘤标志物CEA、NSE、SCC和CYFRA21-1的水平。三组间比较采用Kruskal-Wallis检验,两组间比较采用Mann-Whitney检验,阳性率比较采用卡方检验及Fisher精确检验,并绘制ROC曲线。结果7-TAAB中有6项(p53、SOX2、GAGE7、GBU4-5、MAGEA1和CAGE)的血清水平在NSCLC组均分别高于BLD组(p53:Z=-4.370,P=0.000;SOX2:Z=-4.412,P=0.000;GAGE7:Z=-4.250,P=0.001;GBU4-5:Z=-2.678,P=0.025;MAGEA1:Z=-4.504,P=0.002;CAGE:Z=-4.646,P=0.001)和HC组(p53:Z=-3.543,P=0.000;SOX2:Z=-3.383,P=0.002;GAGE7:Z=-4.893,P=0.001;GBU4-5:Z=-3.381,P=0.025;MAGEA1:Z=-3.369,P=0.001;CAGE:Z=-2.981,P=0.002),差异有统计学意义,PGP9.5项在NSCLC组与BLD组间的差异有统计学意义(Z=-2.871,P=0.044)、与HC组无差异(Z=-2.280,P=0.05),7-TAAB的单项水平在BLD组和HC组差异均无统计学差异(p53:Z=-1.917,P=0.917;PGP9.5:Z=-1.228,P=0.966;SOX2:Z=-1.789,P=0.325;GAGE7:Z=-0.563,P=1.000;GBU4-5:Z=-0.315,P=0.985;MAGEA1:Z=-2.310,P=0.857;CAGE:Z=-2.822,P=0.703)。将7-TAAB检测结果以阴阳性判断,单项自身抗体对NSCLC的特异度均≥89%,但敏感度≤39.5%。以7项中任意1项为阳性即判读为7-TAAB阳性,7-TAAB在早期(Ⅰ、Ⅱ期)NSCLC患者中的阳性率高于传统肺癌肿瘤标志物(7-TAAB:52.94%,CEA:23.53%,NSE:8.82%,CYFRA21-1∶20.59%,SCC:14.71%),对于晚期(Ⅲ、Ⅳ期)和提示预后不良的中低分化NSCLC患者敏感度更高。7-TAAB辅助诊断NSCLC的AUC为0.734,敏感度66.67%,特异度ObjectiveThis study was designed to evaluate the clinical value of seven combinedtumor-associated autoantibodies(7-TAAB)in the diagnosis of non-small cell lung cancer(NSCLC).MethodsThis is a cross-sectional study.The 81 newly diagnosed patients with NSCLC were enrolled.46 patients with benign pulmonary diseases(BLD)and 55 healthy subjects were selected as the BLD group and the healthy control(HC)group,respectively.ELISA was used to detect the concentration of seven TAABs of p53,PGP9.5,SOX2,GAGE7,GBU4-5,MAGE A1 and CAGE in the serum of the NSCLC and the other two groups.The levels of lung cancer tumor markers CEA,NSE,SCC and CYFRA21-1 in serum were also detected in all enrolled subjects.Kruskal-wallis test was used for comparison among the three groups,Mann-Whitney test was used to evaluate the differences between the two groups,and positivity rates were analyzed by using standardχ2 tests and Fisher exact tests.The receiver operating characteristic(ROC)analyses were performed to evaluate the diagnostic efficacy of 7-TAAB or combination of 7-TAAB and traditional tumor markers.ResultsThe serological levels of six TAABs(p53,SOX2,GAGE7,GBU4-5,MAGE A1,and CAGE)in the NSCLC group were higher than that in the BLD group(p53:Z=-4.370,P=0.000;SOX2:Z=-4.412,P=0.000;GAGE7:Z=-4.250,P=0.001;GBU4-5:Z=-2.678,P=0.025;MAGE A1:Z=-4.504,P=0.002;CAGE:Z=-4.646,P=0.001)and the HC group(p53:Z=-3.543,P=0.000;SOX2:Z=-3.383,P=0.002;GAGE7:Z=-4.893,P=0.001;GBU4-5:Z=-3.381,P=0.025;MAGE A1:Z=-3.369,P=0.001;CAGE:Z=-2.981,P=0.002),respectively.The differences were statistically significant.The comparison of PGP9.5 in NSCLC group with that in the BLD group was statistically significant(Z=-2.871,P=0.044),with that in the HC group was no difference(Z=-2.280,P=0.05).None of the seven TAABs showed a significant difference between the BLD group and the HC group(p53:Z=-1.917,P=0.917;PGP9.5:Z=-1.228,P=0.966;SOX2:Z=-1.789,P=0.325;GAGE7:Z=-0.563,P=1.000;GBU4-5:Z=-0.315,P=0.985;MAGE A1:Z=-2.310,P=0.857;CAGE:Z=-2.822,P=0.703).According to the criteria of cu

关 键 词：癌 非小细胞肺 自身抗体 生物标记 肿瘤 早期诊断 

分 类 号：R734.2[医药卫生—肿瘤]