血清miR-486-5p联合CA19-9在可切除和交界性可切除胰腺癌中的预测价值  

Value of serum miR-486-5p combined with carbohydrate antigen 19-9 in predicting resectable or borderline resectable pancreatic cancer

作　　者：张一 张巍巍[1] 谢方瑜 李文利[1] 姜大磊[1] 贾孝娟 付来琳 王尧 陈斌 宋敏[4] 纪莉莎 解祥军[1] ZHANG Yi;ZHANG Weiwei;XIE Fangyu;LI Wenli;JIANG Dalei;JIA Xiaojuan;FU Lailin;WANG Yao;CHEN Bin;SONG Min;JI Lisha;XIE Xiangjun(Department of Gastroenterology,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao,Shandong 266011,China;Department of Cardiology,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao,Shandong 266011,China;Department of Hepatobiliary Surgery,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao,Shandong 266011,China;Endoscope Center,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao,Shandong 266011,China;Dalian Medical University,Dalian,Liaoning 116044,China)

机构地区：[1]青岛大学附属青岛市市立医院消化内科,山东青岛266011 [2]青岛大学附属青岛市市立医院心内科,山东青岛266011 [3]青岛大学附属青岛市市立医院肝胆外科,山东青岛266011 [4]青岛大学附属青岛市市立医院内窥镜室,山东青岛266011 [5]大连医科大学,辽宁大连116044

出　　处：《临床肝胆病杂志》2021年第10期2400-2404,共5页Journal of Clinical Hepatology

基　　金：青岛市民生科技计划项目(19-6-1-22-nsh)。

摘　　要：目的探讨胰腺癌患者血清miR-486-5p的表达水平,以及联合糖链抗原19-9(CA19-9)对胰腺癌可切除性的预测能力。方法选取2018年9月—2020年12月青岛市市立医院确诊的胰腺癌60例,其中可切除和交界性可切除胰腺癌共32例(可手术组),不可切除胰腺癌28例(不可手术组),设置胰腺良性疾病组30例和健康对照组44例。采用实时荧光定量聚合酶链反应(qRT-PCR)检测各组血清miR-486-5p的水平,并计算相对表达量,分析miR-486-5p的相对表达量与胰腺癌临床特征(包括年龄、性别、肿瘤位置、大小、TNM分期、淋巴转移和远处转移)的关系。不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验,计数资料组间比较采用χ^(2)检验。构建受试者工作特征曲线(ROC曲线),通过二元logistic回归计算联合预测值,分析血清miR-486-5p联合CA19-9对胰腺癌可切除性的预测价值。结果可手术组[2.16(1.38~3.30)]和不可手术组[4.65(2.80~9.90)]血清miR-486-5p相对表达量均显著高于胰腺良性疾病组[1.01(0.52~1.53)]和健康对照组[0.99(0.24~1.01)](P值均<0.001)。在TNM分期、有无淋巴转移和有无远处转移中miR-486-5p的低表达和高表达差异有统计学意义(χ^(2)值分别为13.765、5.157、6.638,P值均<0.05)。miR-486-5p+CA19-9区分可手术组与良性疾病组(AUC=0.87,95%CI:0.760~0.942,敏感度81.3%,特异度83.3%)、区分可手术组与健康对照组(AUC=0.92,95%CI:0.836~0.970,敏感度90.6%,特异度86.4%)以及区分可手术组和不可手术组(AUC=0.94,95%CI:0.884~0.998,敏感度85.7%,特异度93.7%)价值优于CA19-9单独检测(Z值分别为2.841、2.510、2.387,P值均<0.05),最佳临界值分别为3.12、3.21和6.63。结论miR-486-5p可作为诊断胰腺癌血清生物标志物,联合CA19-9在胰腺良性疾病和健康人群中预测胰腺癌可切除性的临床价值优于CA19-9。Objective To investigate the expression level of serum miR-486-5p in patients with pancreatic cancer and the value of serum miR-486-5p combined with carbohydrate antigen 19-9(CA19-9)in predicting the resectability of pancreatic cancer.Methods A total of 60 patients who were diagnosed with pancreatic cancer in Qingdao Municipal Hospital from September 2018 to December 2020 were enrolled,among whom 32 patients had resectable or borderline resectable pancreatic cancer(operable group)and 28 had unresectable pancreatic cancer(non-operable group),and a benign pancreatic disease group with 30 patients and a healthy control group with 44 individuals were also established.Quantitative real-time PCR was used to measure the serum level of miR-486-5p in each group,and the relative expression level of miR-486-5p was calculated to analyze its association with the clinical features of pancreatic cancer,including age,sex,tumor location,tumor size,TNM stage,lymphatic metastasis,and distant metastasis.The Mann-Whitney U test was used for comparison of non-normally distributed continuous variables between two groups,and the chi-square test was used for comparison of categorical variables.The receiver operating characteristic(ROC)curve was plotted,and a binary logistic regression analysis was used to calculate the combined predictive value and then investigate the value of serum miR-486-5p combined with CA19-9 in predicting the resectability of pancreatic cancer.Results The relative expression level of serum miR-486-5p in the operable group[2.16(1.38~3.30)]and the non-operable group[4.65(2.80~9.90)]was significantly higher than that in the benign pancreatic disease group[1.01(0.52~1.53)]and the healthy control group[0.99(0.24~1.01)](all P<0.001).There were significant differences in the number of patients with low or high expression of miR-486-5p between the patients with different TNM stages,presence or absence of lymphatic metastasis,and presence or absence of distant metastasis(χ^(2)=13.765,5.157,and 6.638,all P<0.05).Compared w

关 键 词：胰腺肿瘤 微RNAS CA-19-9抗原 

分 类 号：R735.9[医药卫生—肿瘤]