非小细胞肺癌患者血浆PKM2检测的临床意义

Clinical significance of detection of plasma PKM2 in patients with NSCLC

目的检测非小细胞肺癌(NSCLC)患者血浆丙酮酸激酶M2(PKM2)水平,并对其临床应用价值进行探讨。方法选取确诊为NSCLC并行根治性手术的患者94例为手术组;确诊为手术后复发的NSCLC患者30例为复发组;以正常体检者50例为对照组。酶联免疫吸附法(ELISA)检测各组血浆丙酮酸激酶2(PKM2)的水平,同时检测各组单羧酸转运蛋白4(MCT4)及葡萄糖转运蛋白1(GLUT1)的水平。绘制手术组术前及复发组血浆PKM2的ROC曲线。结果血浆PKM2、GLUT1水平3组差异有统计学意义(P<0.05),由高到低依次为复发组、手术组(术前)、对照组(P<0.05);血浆MCT4水平在复发组、手术组(术前)均高于对照组(P<0.05),而复发组与手术组(术前)差异无统计学意义(P>0.05)。手术组患者术后3个指标水平均明显下降,与对照组差异无统计学意义(P>0.05)。Spearman相关分析显示,手术组术前检测中这3个指标间均存在正相关性(P<0.05);复发组中血浆PKM2与GLUT1、PKM2与MCT4存在正相关(P<0.05),而MCT4与GLUT1则无明显相关性(P>0.05)。手术组术前PKM2检测ROC曲线最佳cut-off值为15.78 U/ml,曲线下面积0.873,对诊断NSCLC的敏感度和特异度分别为69.1%、94.0%;复发组曲线最佳cut-off值为16.87 U/ml,曲线下面积为0.965,对诊断NSCLC的敏感度和特异度分别为83.3%、98.0%。结论 NSCLC患者术前及复发时血浆PKM2水平明显升高,检测血浆PKM2水平对诊断NSCLC及预测肿瘤复发有意义。PKM2可能与MCT4、GLUT1相互调节而参与了NSCLC的进展及复发。

Objective To investigate the levels of plasma pyruvate kinase M2 （ PKM2 ） in patients with non-small cell lung cancer （ NSCLC ） , and to evaluate its clinical significance. Methods Ninety-four patients with NSCLC who underwent radical operation were enrolled as surgery group, and the other 30 patients who were diagnosed as postoperative relapse were enrolled as relapse group,at the same time, 50 healthy subjects were served as control group. The plasma levels of PKM2 were detected by ELISA assay, meanwhile, the plasma levels of MCT4 and GLUT1 were detected. Moreover the ROC curves of plasma PKM2 were drawn in both groups. Results There were significantly differences in levels of plasma PKM2,GLUT1 among the three groups （ P 〈0. 05） ,the order from high to low was relapse group, surgery group before operation, control group （ P 〈0. 05）. The plasma levels of MCT4 in relapse group and surgery group before operation were significantly higher than those in control group （ P 〈0.05） , however, there were no significantly differences between relapse group and surgery group before operation （ P 〉0.05） . The levels of PKM2,GLUT1 ,MCT4 in surgery group were significantly decreased after operation （ P 〈0.05） ,but there were no significant differences between surgery group and control group （ P 〉0.05 ） .Spearman correlation analysis showed that there was a positive correlation among the three indexes in surgery group before operation （ P〈 0.05 ）. The plasma levels of PKM2 in relapse group were positivelty correlated to those of GLUT1, MCT4 （P〈0.05） , but the levels of MCT4 were not correlated to those of GLUT1 （P〉 0.05） . The optimal cut-off value of PKM2 in surgery group before operation was 15. 78U/ml, with the area under curve being 0. 873, and sensitivity and specificity in diagnosis of NSCLC were 69.1% ,94.0% Respectively. The optimal cut-off value of PKM2 in relapse group was 16. 87U/ml, with the area under curve being 0. 965, and sensitivity and specificity in diagnosis of NSCLC were 83. 3% , 98. 0% , respectively. Conclusion The plasma levels of PKM2 are obviously increased in patients with NSCLC before operation and at relapse period,therefor,it is valuable to detect plasma levels of PKM2 for diagnosis of NSCLC and prediction of relapse of tumor. Moreover PKM2 may be involved in progress and relapse of NSCLC by regulation with MCT4 or GLUT1 each other.