支气管肺泡灌洗液4种新型肿瘤标志物检测对周围型肺癌的诊断价值

Diagnostic value of 4 new tumor markers in bronchoalveolar lavage fluid in the diagnosis of peripheral lung cancer

目的探讨支气管肺泡灌洗液(BALF)和血清中4种新型肿瘤标志物热休克蛋白90α(HSP90α)、谷胱甘肽S转移酶P1(GSTP1)、泛素特异性肽酶8(USP8)、几丁质酶3样蛋白1(CHI3L1)在周围型肺癌诊断中的临床价值。方法采用酶联免疫吸附法检测100例周围型肺癌住院患者及50例肺部良性疾病患者BALF和血清中HSP90α、GSTP1、USP8、CHI3L1的浓度。分析4种肿瘤标志物含量与不同细胞类型、患者年龄、肺癌分期之间的相关性,以及对周围型肺癌的诊断敏感性和特异性。结果肺癌患者BALF中HSP90α平均浓度显著高于肺部良性疾病显著(P<0.05),诊断敏感性为77.0%,特异性为82.0%;肺癌患者血清中HSP90α平均浓度与肺部良性疾病患者比较差异无统计学意义(P>0.05)。肺癌患者BALF中CHI3L1平均浓度显著高于肺部良性疾病显著(P<0.05),诊断敏感性为72.0%,特异性为80.0%;肺癌患者血清中CHI3L1平均浓度与肺部良性疾病患者比较差异无统计学意义(P>0.05)。小结节肺癌(原发病灶≤1cm)患者BALF中HSP90α及CHI3L1平均浓度与肺部良性疾病患者比较差异无统计学意义(P>0.05)。肺癌患者BALF及血清中USP8、GSTP1平均浓度与肺部良性疾病患者比较差异无统计学意义(P>0.05)。肺癌患者BALF及血清中4种肿瘤标志物浓度与年龄、肺癌分型(腺癌或鳞癌)、肺癌分期(Ⅰ-Ⅳ期)等因素无相关性;CHI3L1在肺癌患者BALF中的浓度与原发灶直径有一定相关性(P<0.05),Pearson相关系数为0.203;其他3种肺癌标志物在BALF、血清中的浓度与肿瘤原发灶直径无相关性。结论检测BALF中HSP90α及CHI3L1浓度对周围型肺癌的诊断有一定价值,且优于血清肿瘤标志物。

Objective To investigate the clinical value of heat shock protein 90et （HSP90ct）, glutathione S-transferase P1 （GSTP1）, ubiquitin specific peptidase 8 （USP8） and chitinase 3-1ike 1 （CHI3L1） in bronchoalveolar lavage fluid （BALF） and serum for diagnosis and evaluation of the extent of peripheral lung cancer. Methods The levels of FISP90et, GSTP1, USP8 and CHI3L1 of in BALF and serum were measured and compared among 100 patients with peripheral lung cancer （PLC） and 50 patients with benign lung diseases （BLD） by ELISA. The results were compared and analyzed. Results The average content of HSP90ct and CHI3L1 in BALF of PLC patients were higher than that in BLD patients （P〈0.05）. The diagnostic sensitivity of HSP90ct and CHI3L1 in BLAF for the diagnosis of lung cancer were respectively 77.0% and 72.0%, and the specificity of them was respectively 82.0% and 80.0%. The levels of HsPg0tx and CHI3L1 in serum of PLC patients and BLD patients showed no significant difference （P〉0.05）. The levels of HSPg0et and CHI3L 1 in BALF of the patients with small nodular lung cancer group （primary focus diameter ≤ lcm） and BLD patients showed no significant difference （P〉0.05）. The levels of GSTP1 and USP8 in BALF and serum of PLC patients and that of BLD patients showed no significant difference （P〉0.05）. The levels of HSP90et, GSTP1, USP8 and CHI3L1 in BALF and serum showed no significant correlation with other factors, such as the patient＇s age, pathological classification （adenocarcinoma or squamous carcinoma） and stage of lung cancer （phase I to IV）. The level of CHI3L1 in BALF was correlated to the diameter of the primary loci （P〈0.05）, while the levels of other lung cancer markers in BALF and serum showed no significant correlation with diameter of primary focus. Conclusion Detection of tumor markers such as HSP90cx and CHI3L1 from patients＇ BALF has a diagnostic value for PLC, and is superior to the examinations of patients＇ serum specimens. The measurement of HSP9Ocx in BALF shows better clinical value, and it may contribute to the diagnosis of peripheral pulmonary carcinoma.