食管癌癌前病变恶性进展分子分型及高发现场推广应用  

Molecular classification and application in high-risk areas of malignant progression of precancerous lesions of esophageal cancer

作　　者：杨苗苗[1] 宋昕[1] 纪爱芳[2] 徐瑞华 魏梦霞 韩文莉 雷玲玲 赵学科[1] 孟超龙 胡守佳[1] 程锟 王盼盼[1] 钟侃 胡景峰 王伟[1] 李欣然 陈瑶 王立东[1] YANG Miaomiao;SONG Xin;JI Aifang;XU Ruihua;WEI Mengxia;HAN Wenli;LEI Lingling;ZHAO Xueke;MENG Chaolong;HU Shoujia;CHENG Kun;WANG Panpan;ZHONG Kan;HU Jingfeng;WANG Wei;LI Xinran;CHEN Yao;WANG Lidong(State Key Laboratory of Esophageal Cancer Prevention&Treatment and Henan Key Laboratory for Esophageal Cancer Research,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Clinical Laboratory,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]郑州大学第一附属医院河南省食管癌重点开放实验室、省部共建食管癌防治国家重点实验室,河南郑州450052 [2]长治医学院附属和平医院医学实验中心,山西长治046000

出　　处：《肿瘤基础与临床》2020年第5期373-377,共5页journal of basic and clinical oncology

基　　金：国家科技部863计划重大专项(2006AA02A403)。

摘　　要：目的探讨食管癌癌前病变恶性进展过程中分子指标变化及其在食管癌高发区人群中的应用价值。方法应用间接酶联免疫吸附试验检测自身抗体[黏蛋白1(MUC1)、P15和ATP7B]在正常对照人群和食管癌患者中的表达差异,评估诊断效能。在食管癌高发区小范围无症状人群进行上述自身抗体检测,同步对比内镜活检病理结果,明确其诊断效益。上述自身抗体联合检测液体活检技术在食管癌高发区大规模无症状人群筛查中应用,并结合内镜活检病理,完成食管癌的早诊筛查防治工作。结果联合检测MUC1、P15和ATP7B等3种自身抗体对食管癌诊断的敏感性分别为单独检测MUC1、P15和ATP7B的2.30倍、2.54倍和3.54倍。自身抗体阳性癌前病变患者恶性进展风险是阴性癌前病变患者的21.895倍。使用MUC1、P15和ATP7B等3种自身抗体联合检测液体活检技术结合内镜活检病理,其早期癌检出率为2.54%。结论优化组合3种自身抗体联合检测液体活检技术可明显提高食管癌检出率,预测癌前病变恶性进展风险;在食管癌高发区采取液体活检和内镜活检病理相结合的方法筛查,可明显降低筛查成本,降低食管癌发病率和死亡率。Objective To investigate the changes of molecular markers in the process of malignant progression of esophageal precancerous lesions and its application value in the population of high incidence area of esophageal cancer.Methods Indirect enzyme-linked immunosorbent assay was used to detect the expression of autoantibodies[mucin 1(MUC1),P15 and ATP7B]in normal controls and patients with esophageal cancer.The above autoantibodies were detected in a small area of asymptomatic population in high incidence area of esophageal cancer,and the results of endoscopic pathological biopsy were compared to determine the diagnostic benefits.Combined with endoscopic pathological biopsy,early diagnosis,screening and prevention of esophageal cancer were completed.Results The sensitivity of combined detection of MUC1 protein,P15 protein and ATP7B in the diagnosis of esophageal cancer was 2.30 times,2.54 times and 3.54 times higher than that of single detection of MUC1,P15 and ATP7B,respectively.The risk of malignant progression in patients with autoantibody positive precancerous lesions was 21.895 times higher than that in patients with negative precancerous lesions.Using MUC1,P15 and ATP7B autoantibodies combined with endoscopic biopsy,the detection rate of early cancer was 2.54%.Conclusion Combined detection of the three kinds of autoantibodies can significantly improve the incidence rate of esophageal cancer and predict the risk of malignant progression of precancerous lesions.Screening in combination with endoscopic biopsy can significantly reduce the cost of screening,and reduce the incidence and mortality of esophageal cancer in high incidence areas of esophageal cancer.

关 键 词：食管癌 癌前病变 恶性进展 分子分型 自身抗体 

分 类 号：R735.1[医药卫生—肿瘤]