癌胚抗原、肿瘤抗原153和环氧化物酶-2在乳腺癌中的表达及意义

发布时间：2018-05-02 01:14

本文选题：乳腺癌 + 癌胚抗原　；参考：《青岛大学》2017年硕士论文

【摘要】：目的检测血清及乳头溢液中癌胚抗原(Carcinoembryonic antigen,CEA)、糖类抗原153(carbohydrate antigen 153,CA153)、组织中环氧化物酶2(cyclooxygenase-2,COX-2)的水平,探讨其在乳腺癌中表达的意义。方法①血清和乳头溢液标本中CA153和CEA检测:收集256例乳腺浸润性导管癌病例作为乳腺癌组(包括86例有乳头溢液患者),60例普通型乳腺导管增生病变伴有乳头溢液者作为良性对照组。用电化学发光法罗氏全自动电化学发光分析仪E-601检测血清及乳头溢液中CEA、CA153的含量,分析血清和乳头溢液CA153和CEA在乳腺癌组与良性对照组之间的差异,比较淋巴结转移、远处脏器转移和复发阳性组与阴性组的差异。②乳腺组织中COX-2检测:选取256例乳腺浸润性导管癌中的128例(包括有乳头溢液的86例)作为乳腺癌组,其中86例有随访资料;癌前病变组(包括89例导管原位癌和57例非典型导管增生)、良性对照组(60例普通型乳腺导管增生病变伴有乳头溢液),用免疫组织化学UltraSensitiveTM S-P法检测不同组别乳腺组织中COX-2的水平,分析COX-2在乳腺癌组与其他组别中表达的差异,比较COX-2与乳腺癌肿瘤大小、发病年龄、组织学分级、肿瘤分期、淋巴结有无转移的关系;③分析血清及乳头溢液中CEA、CA153和组织中COX-2水平的相关性。结果①乳腺癌患者乳头溢液和血清CEA、CA153水平明显高于良性对照组(P0.01),且乳头溢液CA153、CEA检出量明显高于血清(P0.01)。②乳头溢液和血清联合检测敏感性达到97.7%,阴性预测值99.0%。乳头溢液与血清联合检测敏感性较单项指标检测及其他组合比较,差异有统计学意义(P0.05)。单因素分析显示,乳头溢液CA153、CEA可以作为乳腺癌常规检测指标;多因素分析显示,CA153、CEA血清和乳头溢液的联合检测诊断乳腺癌的敏感性、准确性、阴性预测值与各单项检查比较明显提高(P0.05)。③乳腺癌高分级(Ⅲ)组乳头溢液CEA、CA153水平明显高于低分级(Ⅰ+Ⅱ)组;有淋巴结转移与无转移组、复发与无复发乳头溢液CEA、CA153水平比较差异均有统计学意义(P0.01)。④免疫组织化学分析显示COX-2是在普通型乳腺导管增生病变组中仅15.4%(10/60)表达,且表达强度较弱;浸润性导管癌组COX-2(78.9%、101/128)的阳性率高于导管原位癌组(55.1%,49/89)、非典型导管增生组(42.1%,24/57)和普通型乳腺导管增生组,差异均有统计学意义(均P0.05);但导管原位癌与非典型导管增生COX-2表达比较差异无统计学意义(P0.05)。⑤在乳腺癌组中COX-2表达与乳腺癌组织学分级、淋巴结转移、远处转移有关(P0.01),但与年龄相关的表达、肿瘤大小无关(P0.05)。⑥乳腺癌COX-2阳性组CEA和CA153水平明显超过阴性组,差异有统计学意义(P0.05)。结论①CA153、CEA血清和乳头溢液联合检测,比单项检测及其他组合更有意义,可作为乳腺癌的一个单独变量;②乳腺癌患者血清和乳头溢液CA153和CEA与组织中COX-2呈正相关;③检测组织COX-2表达和血清CA153、CEA水平可指导预后评估和随访。
[Abstract]:Objective to detect the level of Carcinoembryonic antigen (CEA), carbohydrate antigen 153 (carbohydrate antigen 153, CA153) and the level of epoxidase 2 (cyclooxygenase-2, COX-2) in the tissues of the serum and nipple discharge, and to explore the significance of its expression in breast cancer. The detection of CA153 and CEA in serum and nipple spillage specimens: 256 cases of milk and milk Adenocarcinoma cases were used as breast cancer group (including 86 cases with nipple discharge), 60 cases of common mammary duct hyperplasia with nipple discharge as benign control group. The content of CEA, CA153 in serum and nipple spillage was detected by electrochemiluminescence Roche automatic electrochemiluminescence analyzer E-601, and serum and nipple spillage was analyzed. The difference of CA153 and CEA between the breast cancer group and the benign control group, compared with the lymph node metastasis, the distant visceral metastasis and the recurrence positive group and the negative group. (2) the COX-2 detection in mammary gland tissue: 128 cases of breast invasive ductal carcinoma (including 86 cases with nipple discharge) were selected as breast cancer group, and 86 cases were followed up. Precancerous lesion group (including 89 cases of ductal carcinoma in situ and 57 cases of atypical ductal hyperplasia), benign control group (60 cases of common mammary duct hyperplasia with nipple discharge), the level of COX-2 in breast tissue of different groups was detected by immunohistochemistry UltraSensitiveTM S-P method, and the difference of COX-2 expression in breast cancer group and other group was analyzed. The correlation between COX-2 and breast cancer size, age, histological grade, tumor staging, lymph node metastasis, and the correlation of CEA, CA153 and COX-2 levels in the serum and nipple spills were analyzed. Results (1) the level of nipple discharge and serum CEA and CA153 in breast cancer patients was significantly higher than that of the benign control group (P0.01), and the nipple discharge CA 153, the detection of CEA was significantly higher than that of serum (P0.01). The sensitivity of the combined detection of nipple discharge and serum was 97.7%, and the negative predictive value of 99.0%. nipple discharge and serum combined detection sensitivity was compared with the single index detection and other combination, the difference was statistically significant (P0.05). The single factor analysis showed that the nipple discharge CA153, CEA could be used as the mammary gland. The multifactor analysis showed that the sensitivity, accuracy and negative predictive value of CA153, CEA serum and nipple discharge in the diagnosis of breast cancer were significantly improved (P0.05). (3) high grade (III) group of breast cancer (III) group nipple discharge CEA, CA153 level was significantly higher than that of low grade (I + II) group; lymph node metastasis and lymph node metastasis There was significant difference in CEA and CA153 levels between relapse and non recurrent nipple discharge (P0.01). (P0.01). (4) immunohistochemical analysis showed that COX-2 was only 15.4% (10/60) expression in the common ductal hyperplasia group and weak expression, and the positive rate of COX-2 (78.9%, 101/128) in invasive ductal carcinoma group was higher than that of catheter in situ. Cancer group (55.1%, 49/89), atypical ductal hyperplasia group (42.1%, 24/57) and common type of mammary duct hyperplasia were statistically significant (P0.05), but there was no significant difference in COX-2 expression between ductal carcinoma in situ and atypical ductal hyperplasia (P0.05). (5) the expression of COX-2 in the breast cancer group and the histological grade of breast cancer, lymph node metastasis, and far away from the breast cancer group. Metastasis related (P0.01), but with age related expression, tumor size was not related (P0.05). (6) the level of CEA and CA153 in COX-2 positive group of breast cancer was significantly higher than that of negative group, and the difference was statistically significant (P0.05). Conclusion (1) CA153, CEA serum and nipple discharge are more significant than single test and other combination, and can be used as a single breast cancer single. The serum and nipple discharge CA153 and CEA of the breast cancer patients were positively related to the COX-2 in the tissues; (3) the expression of COX-2 and the serum CA153 and CEA levels could guide the evaluation and follow-up of the prognosis.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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