检测微小RNA-21对于诊断及评判非小细胞肺癌预后的临床价值

Clinical value of microRNA-21 for the diagnosis and evaluation of prognosis of non-small cell lung cancer

目的明确检测微小RNA-21对于诊断及评判非小细胞肺癌(NSCLC)预后的临床价值。方法前瞻性、连续性纳入我院于2012年1月1日至2013年7月1日期间收治的NSCLC患者,检验患者手术前、放化疗前、放化疗后三个时间段的相关肿瘤标志物指标,并进行为期24个月的随访以确认预后,根据预后再分为健康组及不良预后组,另纳入同期入院的良性病变患者为对照组。比较入选NSCLC患者手术前、放化疗前、放化疗后三个时段相关肿瘤标志物及miRNA-21之间的差异性;并分析miRNA-21与具有组间差异性指标之间的相关性,以此验证该指标的诊断价值。再比较健康组及不良预后组患者性别、年龄、危险因素、病理分型及肿瘤标志物的差异性;将存在显著差异性的指标纳入logistic回归分析以筛选独立危险因素;计算相应指标对于不良预后的评判价值。结果最终纳入实验组患者51例,其中健康组患者30例、不良预后组患者21例,另纳入对照组患者44例。对照组与实验组不同时段的组间资料比较显示:癌胚抗原(CEA)、细胞角质蛋白19片段(CYFRA21-1)、鳞状上皮细胞癌抗原(SCC)、癌抗原19-9(CA19-9)、miRNA-21共5项指标存在显著差异(P均<0.05);其中,放化疗后组miRNA-21与CEA、CYFRA21-1、SCC、CA19-9全部存在显著正性相关(P均<0.05);不同预后组组间资料比较显示:主动吸烟史、肺癌遗传史、手术并发症、腺癌、CYFRA21-1、SCC、miRNA-21存在显著差异性(P均<0.05);其中存在手术并发症、较高的CYFRA21-1、较高的SCC、较高的miRNA-21显著影响其预后;上述三项指标评判NSCLC患者发生不良预后的临界值分别为3.519ng/ml、2.751ng/ml、1.879^(2-△△Ct)。结论 miRNA-21对于不良预后的NSCLC具有良好的评判价值,具备广阔的应用前景。

Objective To study the clinical value of microRNA-21 for the diagnosis and evaluation of prog-nosis of non-small cell lung cancer （ NSCLC） . Methods The related tumor indexes of NSCLC patients from Janu-ary 2012 to July 2013 were examined before surgery, before and 3 months after chemotherapy. They were followed-up for 24 months. According to the prognosis, they were divided into the health group and the poor prognosis group. The differences of tumor indexes and miRNA-21 were analyzed between the two groups. Then the risk factors, pathological type and tumor markers were analyzed by logistic regression to screen independent risk factor. Results The final ex-perimental group included 51 patients, including 30 cases of healthy patients, 21 patients with poor prognosis, and the other included 44 patients in the control group. There were significant differences in CEA, CYFRA21-1, SCC, CA19-9 and miRNA-21 between the two groups （P〈0. 05）. After chemo-radiotherapy, miRNA-21 showed a positive correlation with CEA, CYFRA21-1, SCC and CA19-9 （P 〈0. 05）. There were significant differences in active smoking history, lung cancer genetic history, surgical complications, adenocarcinoma, CYFRA21-1, SCC, and miR-NA-21 （P〈0. 05）, and surgical complications, higher CYFRA21-1, higher SCC, and higher miRNA-21 affected the prognosis most. Three indicators above the critical value judgment NSCLC patients with poor prognosis were 3. 519 ng/ml, 2. 751 ng/ml, and 1. 8792-△△Ct . Conclusion miRNA-21 has good value for the diagnosis of NSCLC and assessing poor prognosis.