血清B7-H3联合肿瘤M2型丙酮酸激酶对肺癌的诊断及病情进展的评估价值  

Diagnostic and prognostic value of serum B7-H3 combined with tumor M2 type pyruvate kinase in lung cancer

作　　者：袁胜芳 王布[1] 项保利[1] 赵建清[1] 张志华[1] 张秀珑[1] YUAN Shengfang;WANG Bu;XIANG Baoli;ZHAO Jianqing;ZHANG Zhihua;ZHANG Xiulong(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院呼吸与危重症医学科,河北张家口075000

出　　处：《大连医科大学学报》2024年第3期221-225,230,共6页Journal of Dalian Medical University

基　　金：河北北方学院省属高校基本科研业务费自然科学项目(JYT2023004)。

摘　　要：目的探讨血清B7-H3和肿瘤M2型丙酮酸激酶(TuM2-PK)对肺癌诊断与病情进展的预测价值。方法选取2020年6月至2021年6月入院治疗的肺癌和肺部良性病变患者137例,其中肺癌患者85例为试验组,肺部良性病变患者52例为对照组。采用ELISA法测定血清中B7-H3和TuM2-PK的表达,并比较是否合并淋巴结转移、不同分期、分化程度及病理类型患者血清中的含量,并绘制ROC曲线评估B7-H3和TuM2-PK对于肺癌的诊断价值,采用DeLong方法对比各指标ROC曲线下面积(AUC)。随访10个月,采用COX回归分析B7-H3和TuM2-PK对于病情进展的影响,采用Spearman相关对血清B7-H3、TuM2-PK水平与无进展生存期(PFS)的相关性进行分析。结果试验组患者血清中的B7-H3和TuM2-PK水平分别为(31.45±6.64)ng/mL和(27.84±7.09)U/mL,均高于对照组的(21.11±7.44)ng/mL和(18.88±6.63)U/mL(P<0.01)。合并淋巴结转移、Ⅲ~Ⅳ期及低中分化患者血清中的B7-H3和TuM2-PK水平均高于无淋巴结转移、Ⅰ~Ⅱ期及高分化患者。COX回归分析显示,肺癌患者血清中的高B7-H3和TuM2-PK浓度均为病情进展的独立危险因素与影响因素(P<0.05),与肺癌患者病情进展相关。Spearman相关性分析显示血清B7-H3和TuM2-PK水平与其PFS均呈负相关(r=−0.806,r=−0.723,P<0.001)。ROC曲线分析结果显示,B7-H3、TuM2-PK及两指标联合诊断肺癌的敏感性分别为76.5%、75.3%和84.7%,特异性分别为76.9%、76.9%和78.8%;AUC分别为0.842(95%CI 0.776~0.908)、0.822(95%CI 0.751~0.893)和0.901(95%CI 0.850~0.953);血清中B7-H3、TuM2-PK最佳截断值分别为26.51 ng/mL和25.12 U/mL。DeLong检验结果显示,两指标联合比单一指标对肺癌有更好的诊断价值(P<0.05)。结论血清中B7-H3和TuM2-PK联合检测对于肺癌的诊断价值高于任何一项单项指标,且两者对病情进展及病理类型具有一定的预测作用。Objective To study the diagnostic and prognostic value of serum B7-H3 and tumor M2 type pyruvate kinase(TuM2-PK)in lung cancer.Methods From June 2020 to June 2021,137 patients with lung cancer and benign lung lesions admitted to our department were selected.Among them,85 patients with lung cancer were divided into the experimental group,and 52 patients with benign lung lesions were divided into the control group.ELISA was used to measure the serum levels of B7-H3 and TuM2-PK,which were compared across different patient groups based on lymph node metastasis,staging,differentiation degree,and pathological types.ROC curves were plotted to evaluate the diagnostic value of B7-H3 and TuM2-PK for lung cancer.The DeLong method was used to measure the area under the ROC curve(AUC)of each indicator.Over a 10-month follow-up period,COX regression analysis was used to investigate the impact of B7-H3 and TuM2-PK on disease progression.Spearman correlation was used to analyze the relationship between serum B7-H3 and TuM2-PK levels and progression free survival(PFS).Results The serum levels of B7-H3 and TuM2-PK in the experimental group were(31.45±6.64)ng/mL and(27.84±7.09)U/mL,respectively,which were higher than those in the control group[(21.11±7.44)ng/mL and(18.88±6.63)U/mL,P<0.01].The serum levels of B7-H3 and TuM2-PK in patients with lymph node metastasis,stageⅢ-Ⅳ,and moderate-to-poor differentiation were higher than those without lymph node metastasis,stageⅠ-Ⅱ,and well differentiation.COX regression analysis indicated that the serum levels of B7-H3 and TuM2-PK in lung cancer patients were independent risk factors(P<0.05)and correlated with disease progression.Spearman correlation analysis showed that serum B7-H3 and TuM2-PK levels were negatively correlated with their PFS(r=−0.806,r=−0.723,P<0.001).The analysis results of the ROC curve showed that the sensitivity of B7-H3,TuM2-PK,and their combined diagnosis were 76.5%,75.3%,and 84.7%,respectively,and the specificity were 76.9%,76.9%,and 78.8%,respectively

关 键 词：肺癌 B7-H3 肿瘤M2型丙酮酸激酶 临床病理 诊断价值 

分 类 号：R561.3[医药卫生—呼吸系统]