肺癌患者血清和胸腔积液B7-H4水平的变化及临床意义

The expression and clinical significance of soluble B7-H4 in serum and pleural effusion in lung cancer

目的探讨血清及胸腔积液中B7-H4水平变化对肺癌患者的临床意义。方法选择2014年1月—2015年7月山东省潍坊市人民医院肿瘤内科诊治合并有恶性胸腔积液的肺癌患者65例(肺癌组)和合并胸腔积液的肺部良性疾病患者33例(对照组),ELISA法检测其血清及胸腔积液中B7-H4的含量,并比较2组水平差异。分析B7-H4与肿瘤患者临床资料的关系,并通过ROC分析其对肺癌的诊断价值。结果肺癌组患者血清及胸腔积液内B7-H4的含量显著高于对照组(P<0.01),且B7-H4含量与TNM分期和肿瘤转移情况有关。经Spearman相关分析,肺癌组患者中血清B7-H4与血清CEA呈正相关(r=0.232,P<0.01),与血清CYFRA21-1无相关性(r=0.350,P>0.05);胸腔积液所-H4水平与胸腔积液CEA、CYFRA21-1呈正相关(r=0.416,P<0.01;r=0.324,P<0.05)。血清B7-H4用于诊断肺癌的AUC为0.807,最佳临界值为33.86 ng/ml,诊断的敏感度为72.7%,特异度为76.2%;胸腔积液B7-H4用于诊断恶性胸腔积液的AUC为0.848,最佳临界值为50.3 ng/ml,诊断的敏感度为72.3%,特异度为81.8%。结论肺癌患者血清及胸腔积液B7-H4水平均升高,且与肿瘤分期、转移有关,血清B7-H4可用于肺癌的辅助诊断,胸腔积液B7-H4可用于良恶性胸腔积液的鉴别诊断。

Objective To explore the clinical significance of the level changes of B7-H4 in serum and pleural effusion for patients with lung cancer.Methods Sixty-five lung cancer patients with malignant pleural effusion（lung cancer group） and 33 benign pulmonary disease patients with pleural effusion（control group） in our hospital from January 2014 to July 2015 were rolled in this study.The levels of B7-H4 in serum and pleural effusion were detected by enzyme-linked immunosorbent assay（ELISA）,and the level differences of the two group were compared.The relationship between B7-H4 and clinical data of tumor patients was analysed,and the ROC analysis were used to estimate the diagnosis value of the B7-H4 for lung cancer.Results The serum and pleural effusion levels of the B7-H4 in lung cancer patients were significantly higher than those of the control group（P〈0.01）.The serum and pleural effusion levels of B7-H4 in lung eancer patients were associated with TNM stages and tumor metastasis.The serum B7-H4 level in lung cancer patients was positively correlated with serum CEA（r =0.232,P〈0.01） and was not related to serum CYFRA21-1（r =0.350,P〉0.05） through the Spearman correlation analysis.The level of B7-H4 in pleural effusion was positively correlated with CEA and CYFRA21-1 in pleural effusion（r =0.416,P〈0.01;r =0.324,P〈0.05）.The AUC of serum B7-H4 for diagnosis of lung cancer was 0.807,and the best threshold value was 33.86 ng/ml with a sensitivity of 72.7%and a specificity of 76.2%.and the AUC of pleural effusion B7-H4 for diagnosis of malignant pleural effusion was 0.848,and the best threshold value was 50.3 ng/ml with a sensitivity of72.3%and a specificity of 81.8%.Conclusion The serum and pleural effusion levels of B7-H4 were increased in lung patients,and associated with the stages and metastasis of the tumor.The serum B7-H4 might be an helpful diagnosis of lung cancer,and the pleural effusion B7-H4 might be a good biomarker in the differential diagnoses of malignant/benign pleural effusion.