胃癌发生发展中血清骨桥蛋白水平变化及其临床意义

Changes in serum osteopontin level and its clinical significance in carcinogenesis and development of gastric cancer

目的揭示血清骨桥蛋白(OPN)在胃癌发生发展过程中的变化趋势,探讨其在胃癌诊断及早期胃癌与进展期胃癌鉴别诊断中的应用价值。方法用酶联免疫吸附法对70例进展期胃癌、24例早期胃癌、47例不典型增生、42例肠上皮化生、46例慢性浅表性胃炎患者和38名正常对照者进行血清OPN水平检测。结果胃癌组血清OPN水平(57.03ng/ml)显著高于其他各组;进展期胃癌血清OPN水平(66.05ng/ml)显著高于早期胃癌(41.93ng/ml),早期胃癌显著高于不典型增生、肠上皮化生和慢性浅表性胃炎组,后三者均显著低于正常对照组(均P<0.05)。血清OPN诊断胃癌的ROC曲线下面积为0.824±0.028;OPN检测的灵敏度和特异度,在胃癌为68.09%和82.66%;进展期胃癌为64.29%和89.85%;早期胃癌为33.33%和91.39%。结论胃癌发生发展过程中,血清OPN水平在癌前期各阶段降低,癌形成阶段呈进行性升高趋势;血清OPN是胃癌诊断的一种较理想的标志物,其对早期胃癌与进展期胃癌的鉴别诊断具有较高的临床应用价值。

Objective To reveal the change tendency of serum osteopontin（OPN） in carcinogenesis and development of gastric cancer （ GC ）, and explore the usefulness of serum OPN in the diagnosis of GC and the differential diagnosis of early GC and advanced GC. Method Serum OPN levels were detected by enzyme-linked immunosorbent assay, including 70 advanced GC, 24 early GC, 47 dysplasia, 42 intestinal metaplasia, 46 chronic superficial gastritis patients and 38 normal controls. Results Serum OPN level in GC group （57. 03 ng/ml） was significantly higher than those in other groups. Serum OPN level in advanced GC group （66. 05 ng/ml） was significantly higher than that in early GC group （41.93 ng/ml）, serum OPN level in early GC group was significantly higher than those in dysplasia, intestinal metaplasia and chronic superficial gastritis, and serum OPN level in the latter three groups was significantly lower than that in normal controls （P 〈 0. 05, respectively）. The areas under ROC curve of serum OPN to diagnose GC was 0. 824 ± 0. 028. When the cut-off for diagnosis of GC and advanced GC was 40. 72 ng/ml and 50. 06 ng/ml respectively, and the value for early GC was between the above values, the sensitivity and specificity were 68.09%, 82.66% in GC; 64.29%, 89.85% in advanced GC and 33.33%, 91.39% in early GC, respectively. Conclusions In carcinogenesis and development of GC, the serum OPN level appears to drop at the each gastric precancerous stage, and to progressively go up at GC stage. Serum OPN is an ideal tumor marker for diagnosis of GC. It could have higher value in clinical application for the differential diagnosis of early GC and advanced GC.