胆管癌患者血清肿瘤型M2丙酮酸激酶水平变化及临床意义  

Changes in serum level of tumor type M2 pyruvate kinase in patients with cholangiocarcinoma and its clinical significance

作　　者：王金[1] 赵一洁[2] 尚培中[1] 孙永杰 贾国洪[1] 李晓武[1] WANG Jin;ZHAO Yijie;SHANG Peizhong;SUN Yongjie;JIA Guohong;LI Xiaowu(Department of General Surgery,the 251st Hospital of PLA,Zhangjiakou,Hebei 075000,China;Library of Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Cardiothoracic Surgery,the 251st Hospital of PLA,Zhangjiakou,Hebei 075000,China)

机构地区：[1]中国人民解放军第二五一医院普通外科,河北张家口075000 [2]河北北方学院图书馆,河北张家口075000 [3]中国人民解放军第二五一医院心胸外科,河北张家口075000

出　　处：《中国普通外科杂志》2020年第2期220-227,共8页China Journal of General Surgery

基　　金：河北省卫计委科研基金资助项目(20181179)。

摘　　要：背景与目的:胆管癌临床起病隐匿,早期诊断困难,患者确诊时大多数已属晚期,并失去了根治性治疗的机会。因此,寻找一种新的生物标志物用于胆管癌早期诊断或评估治疗及预后具有极为重要的意义。肿瘤型M2丙酮酸激酶(TuM2-PK)是近年来发现的一种肿瘤标志物,可能与多种肿瘤相关。因此,本研究探讨胆管癌患者血清TuM2-PK水平的变化及其在胆管癌诊断中的价值。方法:比较54例胆管癌患者、32例胆管结石患者及25例健康体检者血清TuM2-PK水平;以TuM2-PK>15 U/mL为阳性判定标准,分析胆管癌患者血清TuM2-PK阳性率与临床参数的关系。采用ROC曲线分析血清TuM2-PK水平对胆管癌的诊断效能,并与CA19-9比较。最后分别比较胆管癌患者、胆管结石患者以及胆管癌患者中根治性手术、姑息性手术患者手术前后血清TuM2-PK水平的变化。结果:胆管癌患者血清TuM2-PK水平明显高于胆管结石患者及健康人群(均P<0.05),而后两者间差异无统计学意义(P>0.05);胆管癌患者血清TuM2-PK阳性率与肿瘤分化程度、淋巴结转移、临床TNM分期明显有关(均P<0.05)。血清TuM2-PK诊断胆管癌的AUC值为0.781,灵敏度为84.81%、特异度为80.00%;血清CA19-9诊断胆管癌的灵敏度为79.63%、特异度为84.00%;两者联合检测的敏感度增高,但特异度降低。胆管癌患者术后血清TuM2-PK水平较术前明显降低(P<0.05),胆管结石患者手术前后血清TuM2-PK水平无明显差异(P>0.05);胆管癌患者中,行根治性手术患者术后血清TuM2-PK水平较术前明显降低(P<0.05),姑息性手术患者无明显变化(P>0.05)。结论:胆管癌患血清TuM2-PK水平升高,其水平与肿瘤的进展及治疗效果密切相关,对于胆管癌的早期诊断以及治疗效果与预后的判断有一定价值。Background and Aims:Cholangiocarcinoma is insidious in its clinical onset,its early detection is difficult,and many patients are at an advanced stage at the time of diagnosis,thus lose the chance of radical treatment.Therefore,the search for a new biomarker for early diagnosis and prediction of treatment efficacy and prognosis of cholangiocarcinoma is of great importance.The tumor type M2 pyruvate kinase (TuM2-PK) To investigate the value of serum tumor type M2 pyruvate kinase is a tumor biomarker discovered in recent years,and may be associated with a variety of tumors.This study was conducted to investigate the change in serum TuM2-PK level in cholangiocarcinoma patients and its diagnostic value for cholangiocarcinoma.Methods:The serum TuM2-PK levels in 54 patients with cholangiocarcinoma,32 patients with bile duct stones and 25 subjects undergoing health maintenance examination were compared.Using TuM2-PK>15 U/mL as the positive standard,the relations of positive rate of the serum TuM2-PK with clinical factors of the cholangiocarcinoma patients were analyzed.The diagnostic efficacy of the serum TuM2-PK level for cholangiocarcinoma was determined by using ROC curve analysis,which was compared with that of CA19-9.Finally,the pre-and postoperative changes in serum TuM2-PK level in cholangiocarcinoma patients and patients with bile duct stones as well as in cholangiocarcinoma patients undergoing radical operation or palliative operation were respectively compared.Results:The serum TuM2-PK level in cholangiocarcinoma patients was significantly higher than that in patients with bile duct stones or healthy individuals (both P<0.05),while it showed no significant difference between the latter two groups (P>0.05).The positive rate of TuM2-PK in the cholangiocarcinoma patients was significantly associated with the degree of tumor differentiation,lymph node metastasis and clinical TNM stage (all P<0.05).The AUC value of serum TuM2-PK for diagnosis of cholangiocarcinoma was 0.781,with a sensitivity of 84.81% and a specifi

关 键 词：胆管肿瘤/诊断 丙酮酸激酶 生物标记 肿瘤 

分 类 号：R735.8[医药卫生—肿瘤]