肿瘤型M2-丙酮酸激酶在乳腺癌诊断与疗效监测中的价值

Diagnostic value of tumor type M2 pyruvate kinase in patients with breast cancer

目的评估肿瘤型M2-丙酮酸激酶（TUM2-PK）在乳腺癌诊断与疗效监测中的应用价值。方法用ELISA检测63例乳腺癌患者、22例乳腺良性疾病患者及4｜D名健康对照者血浆TUM2-PK水平，并与糖类抗原15-3（CAl5-3）、癌胚抗原（CEA）测定结果对比分析。结果根据受试者工作特征（ROC）曲线分析，TuM2．PK检测乳腺癌的临界值为14．1U／ml，敏感度为46．0％，特异度为86．0％，提示其诊断价值高于CAl5-3（敏感度为42．8％，特异度为85．4％）和CEA（敏感度为36．5％，特异度为90．0％）。乳腺癌患者血浆中TU M2-PK水平（13．3U／ml）明显高于健康对照（7．2U／ml，U=408．5，P〈0．05）以及乳腺良性疾病患者（11．1U／ml，U=509．0，P〈0．05）。乳腺癌患者血浆TU M2-PK水平及敏感度随着肿瘤分期、分级的升高而升高；淋巴结转移患者TU M2-PK水平（23．3U／ml）显著高于未转移者（10．9U／ml，U=237．0，P〈0．01）。TuM2-PK水平与疗效密切相关，病情恶化或出现转移时TU M2-PK升高，在临床治疗有效时又有所下降；而患者病情稳定时，基本维持在同一水平。结论TU M2-PK测定可提高对乳腺癌诊断的敏感度，是乳腺癌患者病情监测、疗效观察及预后判断的有效指标。

Objective To evaluate application value of plasma tumor type M2 pyruvate kinase （TU M2-PK） in the treatment effect monitoring in breast cancer. Methods TU M2-PK was determined by ELISA in breast cancer patients （ n = 63）, benign breast disease patients （ n = 22） and health controls （ n = 40）. The receiver operation characteristic （ROC） analysis was performed as compared with CA15-3 and CEA. Results ROC analysis showed the cut-off was set at 14. 1 U/ml for TU M2-PK （ sensitivity 46. 0% ; specificity 86. 0% ）, and the diagnosis efficacy of TU M2-PK was higher than CA15-3 and CEA. The level of TU M2-PK was significantly higher in breast cancer patients （ 13.3 U/ml） than that in health controls （7.2 U/ml, U = 408. 5, P 〈 0.05 ） and in benign breast disease patients （ 11.1 U/ml, U = 509. 0, P 〈 0.05 ）. With the progression of breast carcinoma, the level of TU M2-PK as well as the positivity was increased. TU M2-PK concentration was higher in patients with lymph node metastasis （23.3 U/ml） than those without metastasis （ 10.9 U/ml, U = 237. 0, P 〈 0.01 ）. The level of TU M2-PK correlated with therapy response. An elevated level of TU M2-PK was found preclinically in recurrent disease patients, and the levels decreased in the patients, which showed sensitive to chemotherapy. The TU M2-PK level was kept at baseline in patients with stable disease. Conclusion TU M2-PK is helpful in the diagnosis of breast cancer, and it is a valuable tumor marker for disease monitoring, therapy control and prognosis evaluation in breast cancer.