血清sTim-3和YKL-40水平与早期胃癌内镜黏膜下剥离术后复发的关系

Relationship between serum sTim-3 and YKL-40 levels and recurrence after endoscopic submucosal dissection for early gastric cancer

目的探讨血清可溶性T细胞免疫球蛋白黏蛋白分子3(sTim-3)、几丁质酶样蛋白40(YKL-40)水平与早期胃癌内镜黏膜下剥离术后复发的关系。方法收集河北北方学院附属第一医院2018年6月-2020年6月期间住院并进行内镜黏膜下剥离术的397例早期胃癌患者作为研究组,根据是否复发将其分为复发组(n=18)和未复发组(n=379),另选取同时期96例经病理检测证实为良性病变者作为对照组。采用ELISA法检测血清sTim-3、YKL-40表达水平,并比较复发组与未复发组血清sTim-3、YKL-40表达水平及临床病理特征;采用多因素logistic回归分析早期胃癌患者术后复发的影响因素;运用ROC曲线分析早期胃癌患者血清sTim-3、YKL-40水平对术后复发的预测价值。结果研究组中sTim-3、YKL-40表达水平分别为(2055.86±207.97)ng/L、(81.81±8.42)ng/mL,均显著高于对照组(1832.43±192.06)ng/L、(73.57±7.68)ng/mL,差异均有统计学意义(t=9.583、8.748,P均<0.05)。早期胃癌术后复发组s Tim-3、YKL-40表达水平明显高于未复发组(t=7.665、6.926,P均<0.001),而黏膜下浸润比例明显高于未复发组(t=4.455,P<0.05)。血清sTim-3、YKL-40、浸润深度是早期胃癌患者术后复发的独立危险因素(P均<0.05)。血清s Tim-3、YKL-40预测早期胃癌患者术后复发的曲线下面积(AUC)分别为0.891、0.877。二者联合预测术后复发的AUC为0.979,优于sTim-3、YKL-40各自单独预测(Z=1.986、2.892,P=0.047、0.004)。结论早期胃癌患者血清sTim-3、YKL-40表达水平均显著升高,与患者内镜黏膜下剥离术后复发有着紧密联系。

Objective To investigate the relationship between serum levels of soluble T cell immunoglobulin and mucin-domain containing molecule-3(sTim-3)and chitinase like protein 40(YKL-40)and recurrence after endoscopic submucosal dissection for early gastric cancer.Methods A total of 397 early gastric cancer patients hospitalized and underwent endoscopic submucosal dissection in the First Affiliated Hospital of Hebei North University from June 2018 to June 2020 were collected as the study group.They were separated into a recurrence group(n=18)and a non-recurrence group(n=379)based on whether they recurred.Another 96 cases of benign lesions confirmed by pathological examination were as the control group.ELISA was applied to detect the expression levels of sTim-3 and YKL-40 in serum;the expression levels and clinical pathological characteristics of sTim-3 and YKL-40 in the serum of patients in the recurrence group and non-recurrence group were compared;multivariate logistic regression was applied to analyze the influencing factors of postoperative recurrence in early gastric cancer patients;receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum sTim-3 and YKL-40 in early gastric cancer patients for postoperative recurrence.Results The expression levels of sTim-3 and YKL-40 were(2055.86±207.97)ng/L and(81.81±8.42)ng/mL,respectively,which were significantly higher than those of the control group(1832.43±192.06)ng/L and(73.57±7.68)ng/mL,with significant differences(t=9.583,8.748;all P<0.05).The expression levels of sTim-3 and YKL-40 in the recurrence group were obviously higher than those in the non-recurrence group(t=7.665,6.926;all P<0.001),and the proportion of submucosal infiltration was obviously higher than that in the non-recurrence group(t=4.455,P<0.05);serum sTim-3,YKL-40,and depth of infiltration were independent risk factors for postoperative recurrence in early gastric cancer patients(P<0.05);the areas under the curve(AUC)of serum sTim-3 and YKL-40 in predicting postoperative recurrence in early gastric cancer patients were 0.891 and 0.877,respectively;the AUC of postoperative recurrence predicted by the combination of the two was 0.979,which was better than their individual predictions(Z=1.986,2.892;P=0.047,0.004).Conclusion The expression levels of sTim-3 and YKL-40 in serum of early gastric cancer patients were obviously increased,which were closely related to the recurrence of patients after endoscopic submucosal dissection.