sB7-H4和CEA检测对良、恶性胸腔积液的鉴别诊断价值

发布时间：2018-03-03 16:52

  本文选题：可溶性B7-H4　切入点：癌胚抗原　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的:负性协同刺激分子B7-H4是B7家族中的新兴成员,它通过抑制T细胞的增殖、活化,减少细胞因子的合成、分泌,阻滞细胞周期的进程,从而下调免疫应答,与肿瘤免疫逃逸有关。B7-H4在多种恶性肿瘤组织和血清中普遍高表达,前期研究已证实,B7-H4在恶性胸腔积液中亦呈现出高水平表达。本研究初步探讨胸腔积液中可溶性B7-H4(sB7-H4)和癌胚抗原(CEA)单独或联合检测对良、恶性胸腔积液的鉴别诊断价值。方法:收集2015年1月至2015年12月郑州大学第一附属医院收治的97例初治胸腔积液患者的胸液标本,其中恶性胸腔积液(MPE)55例,良性胸腔积液(BPE)42例。应用酶联免疫吸附法(ELISA)检测sB7-H4浓度,应用电化学发光法检测CEA水平,采用受试者工作特征曲线(ROC曲线)分析和评价sB7-H4和CEA单独或联合检测对良、恶性胸腔积液的鉴别诊断价值。sB7-H4和CEA之间的关联性采用Pearson积矩相关分析进行。结果:(1)MPE组和BPE组患者的胸腔积液sB7-H4水平分别为(60.08±35.04)ng/ml versus(27.26±9.55)ng/ml,CEA水平分别为(41.49±37.16)ng/ml versus(2.41±0.94)ng/ml,差异均具有统计学意义(P0.01)。(2)胸腔积液sB7-H4诊断MPE的ROC曲线下面积(AUC)为0.884,根据ROC曲线分析得出sB7-H4诊断MPE的最佳临床诊断临界值为37.25ng/ml,灵敏度和特异度分别为81.82%和90.48%;CEA的AUC为0.954,最佳临床诊断临界值为4.18 ng/ml,灵敏度和特异度分别为87.28%和95.24%。两者联合检测时:在并联试验(即:当sB7-H437.25ng/ml或CEA4.18ng/ml时,则判定为MPE,反之则为BPE)中,灵敏度可提高到90.91%,但特异度降低至88.10%;在串联试验(即:当sB7-H437.25ng/ml且CEA4.18ng/ml时,则判定为MPE,反之则为BPE)中,灵敏度下降至78.18%,而特异度可提高到97.62%。(3)MPE组胸腔积液sB7-H4水平与CEA含量呈正相关(P=0.001,r=0.470),BPE组两者亦呈正相关(P=0.001,r=0.002)。结论:胸腔积液sB7-H4可用于良、恶性胸腔积液的鉴别诊断,但未优于CEA。sB7-H4和CEA联合检测可提高诊断MPE的灵敏度和特异度。
[Abstract]:Background & AIM: negative co-stimulator B7-H4 is a new member of the B7 family. It down-regulates the immune response by inhibiting T cell proliferation, activation, reducing cytokines synthesis, secretion and blocking the progress of cell cycle. B7-H4 is generally overexpressed in various malignant tumor tissues and serum, which is related to tumor immune escape. Previous studies have confirmed that the expression of B7-H4 in malignant pleural effusion is also high. In this study, we preliminarily studied the detection of soluble B7-H4sB7-H4 and carcinoembryonic antigen (CEA) in pleural effusion. Methods: from January 2015 to December 2015, 97 cases of pleural effusion were collected from the first affiliated Hospital of Zhengzhou University, including 55 cases of malignant pleural effusion. A total of 42 cases of benign pleural effusion were examined for sB7-H4 concentration by enzyme linked immunosorbent assay (Elisa), CEA level by electrochemiluminescence (ECL), and sB7-H4 and CEA were analyzed and evaluated by single or combined detection of sB7-H4 and CEA in 42 cases of benign pleural effusion. The correlation between sB7-H4 and CEA in malignant pleural effusion was analyzed by Pearson moment correlation analysis. Results the level of sB7-H4 in the pleural effusion of the patients in the BPE group and the control group was 60.08 卤35.04 ng / ml versus(27.26 卤9.55 ng / ml versus(27.26 respectively, and the level of sB7-H4 was 41.49 卤37.16 ng / ml versus(2.41 卤0.94 ng / ml, respectively. The difference was statistically significant. The area under the ROC curve of sB7-H4 in the diagnosis of MPE in pleural effusion was 0.884. According to the analysis of ROC curve, the critical value of sB7-H4 diagnosis for MPE was 37.25 ng / ml, the AUC of sensitivity and specificity were 81.82% and 90.48g / ml, respectively, and the best clinical diagnosis was best. The critical value is 4.18ng / ml, the sensitivity and specificity are 87.28% and 95.24.When the two are combined, they are tested in parallel (i.e. when sB7-H437.25ng/ml or CEA4.18ng/ml, In MPEG, the sensitivity can be increased to 90.91, but the specificity is reduced to 88.10; in the series test (that is, MPEG when sB7-H437.25ng/ml and CEA4.18ng/ml are determined, and BPEwhen vice versa), the sensitivity of MPEG can be increased to 90.91, but the specificity will be reduced to 88.10. The sensitivity decreased to 78.18, and the specificity increased to 97.62.The level of sB7-H4 in pleural effusion was positively correlated with the content of CEA. Conclusion: sB7-H4 in pleural effusion can be used in the differential diagnosis of benign and malignant pleural effusion. But not better than CEA.sB7-H4 and CEA combined detection can improve the sensitivity and specificity of MPE diagnosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R561.3;R730.4
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本文编号：1561881