MACC1和c-MET检测在肺腺癌并发恶性胸腔积液中的诊断价值

发布时间：2019-03-24 12:00

【摘要】：背景恶性胸腔积液(MPE)是常见的渗出性胸腔积液,在约15%的肺癌患者中,胸腔积液可为其首发症状,而随着病情进展,出现恶性胸腔积液的患者达50%。MPE常在NSCLC进展中出现,尤其是腺癌最多见,伴有MPE的肺腺癌是全身性疾病,不能通过手术或放疗治疗。并发MPE即是肺癌晚期,意味着病情进展和预后不良,并严重影响患者的生存质量。故明确胸腔积液的病因具有重要的临床意义,尤其是鉴别良、恶性胸腔积液。目前MPE的诊断依赖于胸腔积液的细胞学分析,但其诊断的敏感性较低(30%-60%)。肿瘤标志物已在临床被广泛用于协助诊断MPE。其中癌胚抗原(CEA)最常应用,并对诊断肺腺癌最有价值,然而单项实验室指标均有不同程度的假阳性或假阴性存在,不能满足临床工作的需要。所以在实际工作中往往需要多项实验室指标的联合检测才能提高胸腔积液诊断的准确性。目的探讨结肠癌转移相关因子-1(MACC1)、间质-上皮细胞转化因子(c-MET)联合癌胚抗原(CEA)在肺腺癌并发MPE中的诊断价值。方法将91例胸腔积液患者(良性38例,肺腺癌53例)纳入研究,采用酶联免疫吸附试验(ELISA)法测定血清和胸腔积液中MACC1、c-MET浓度,通过放射免疫法测定血清和胸腔积液中CEA浓度,并分别分析三个指标的临床相关性。结果肺腺癌并发恶性胸腔积液中MACC1、c-MET和CEA浓度明显高于良性胸腔积液,差异均有统计学意义(P0.05);两组患者的血清MACC1和c-MET浓度无统计学差异(P0.05),而血清CEA浓度系恶性组高于良性组,差异有统计学意义(P0.05)。胸腔积液中MACC1和c-MET含量呈正相关(r=0.728,P0.01)。根据ROC曲线,以MACC1浓度90.98pg/ml为临界值,对肺腺癌并发恶性胸腔积液的诊断灵敏性为62.26%,特异性为84.21%;c-MET浓度757.67ng/ml为临界值,肺腺癌恶性胸腔积液的诊断灵敏性为52.83%,特异性为84.21%。MACC1联合c-MET检测,灵敏性(并联)为75.47%,特异性(串联)为92.11%;MACC1、c-MET联合CEA诊断的灵敏性(并联)为98.11%,特异性(串联)为97.37%。结论MACC1和c-MET在肺腺癌并发恶性胸腔积液中升高,与患者性别、年龄、吸烟史、及有无淋巴结和远处转移无相关性。MACC1或c-MET诊断肺腺癌并发恶性胸腔积液的特异性和敏感性均不优于CEA,但二者与CEA联合检测可提高诊断的灵敏性和特异性。
[Abstract]:Background malignant pleural effusion (MPE) is a common exudative pleural effusion, in about 15% of patients with lung cancer, pleural effusion can be the first symptom, and with the development of the disease, In patients with malignant pleural effusion, 50%.MPE often occurs in the progression of NSCLC, especially adenocarcinoma. Lung adenocarcinoma with MPE is a systemic disease and cannot be treated by surgery or radiotherapy. MPE is a late stage of lung cancer, which means that the progress and prognosis of lung cancer is poor, and the quality of life of the patients is seriously affected. Therefore, it has important clinical significance to clarify the etiology of pleural effusion, especially to distinguish benign and malignant pleural effusions. At present, the diagnosis of MPE depends on cytological analysis of pleural effusion, but its sensitivity is low (30% to 60%). Tumor markers have been widely used clinically to assist in the diagnosis of MPE. Carcinoembryonic antigen (CEA) is the most commonly used and has the most value in diagnosing lung adenocarcinoma. However, the single laboratory indexes have different degrees of false-positive or false-negative, which can not meet the needs of clinical work. Therefore, in practical work, many laboratory indicators are often needed to improve the accuracy of pleural effusion diagnosis. Objective to investigate the diagnostic value of metastasis-related factor-1 (MACC1), mesenchymal-epithelial cell transformation factor (c-MET) and carcinoembryonic antigen (CEA) in lung adenocarcinoma complicated with MPE. Methods 91 patients with pleural effusion (38 benign and 53 lung adenocarcinoma) were enrolled in the study. The concentration of MACC1,c-MET in serum and pleural effusion was measured by enzyme linked immunosorbent assay (ELISA). The concentrations of CEA in serum and pleural effusions were measured by radioimmunoassay, and the clinical correlation of the three indexes were analyzed. Results the concentrations of MACC1,c-MET and CEA in malignant pleural effusions in lung adenocarcinoma were significantly higher than those in benign pleural effusions (P0.05). There was no significant difference in serum MACC1 and c-MET concentration between the two groups (P0.05), but the serum CEA concentration in malignant group was significantly higher than that in benign group (P0.05). There was a positive correlation between MACC1 and c-MET in pleural effusion (r = 0.728, P0.01). According to the ROC curve, the sensitivity and specificity were 62.26% and 84.21% for lung adenocarcinoma complicated with malignant pleural effusion according to the 90.98pg/ml concentration of MACC1 as the critical value. The diagnostic sensitivity of malignant pleural effusion in lung adenocarcinoma was 52.83%, the specificity was 84.21%.MACC1 combined with c-MET detection, and the sensitivity (parallel) was 75.47%, when the concentration of c-MET was the critical value, the diagnostic sensitivity of malignant pleural effusions in lung adenocarcinoma was 52.83%. The specificity (tandem) was 92.11%; The sensitivity (parallel) and specificity (series) of MACC1,c-MET combined with CEA were 98.11% and 97.37% respectively. Conclusion MACC1 and c-MET were elevated in lung adenocarcinoma complicated with malignant pleural effusion, and correlated with sex, age and smoking history. There was no correlation between lymph node and distant metastasis. The specificity and sensitivity of MACC1 or c-MET in diagnosing lung adenocarcinoma complicated with malignant pleural effusion were not better than those of CEA, but the sensitivity and specificity could be improved by the combination of MACC1 and CEA.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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