上皮性卵巢癌血清Smac表达的临床意义

The Clinical Significance of Detection of Serum Smac in Epithelial Ovarian Cancer

目的:探讨血清Smac检测在上皮性卵巢癌(EOC)诊断和病情监测中的临床意义。方法:选取2015年12月—2017年1月于天津市中心妇产科医院经手术治疗的100例卵巢肿物患者,术后病理诊断明确,根据良恶性分为卵巢良性肿瘤组40例,上皮性卵巢癌组60例;另选取本院体检合格的健康对照组40例。分别收集手术前后及化疗过程中的清晨空腹血清,采用酶联免疫吸附法(ELISA)检测血清Smac水平。结果:血清Smac在上皮性卵巢癌组中的表达水平低于健康对照组和卵巢良性肿瘤组(P<0.05);根据受试者工作特征(ROC)曲线,确定血清Smac表达的临界值为429.39 pmol/L,Smac检测的敏感度为91.67%,特异度为95%;Smac在Ⅰ+Ⅱ期EOC的阳性数为14例,阳性率为87.50%;在Ⅲ+Ⅳ期的阳性数为41例,阳性率为93.18%,差异无统计学意义(P>0.05);在EOC中,血清Smac与患者年龄、病理类型、有无腹水、中性粒细胞/淋巴细胞(NLR)和血小板/淋巴细胞(PLR)无关,与国际妇产科联盟(FIGO)分期和淋巴结转移有关;手术后血清Smac的表达水平高于术前,差异有统计学意义(P=0.000),随着化疗次数的增加,Smac表达水平逐渐升高,Smac在第2疗程结束后升至正常。结论:血清Smac表达水平对EOC的早期诊断,鉴别卵巢良恶性肿瘤及EOC术后的病情监测均有一定临床价值。

Objective:To investigate the clinical significance of serum Smac level in diagnosis and illness monitoring of epithelial ovarian carcinoma. Methods:The study collected 100 patients with ovary tumor who experienced the surgical treatment in Tianjin Central Hospital of Gynecology Obstetrics from December 2015 to January 2017. According to the pathological diagnosis of benign and malignant, all seclected patients were divided into benign ovarian tumor group( n=40) and epithelial ovarian cancer group(n=60). In addition to seclect the health control group(n=40) after medical examinationin in our hospital. Fasting serum were collected before and after surgery and chemotherapy. The level of serum Smac was detected by ELISA. Results:Serum Smac expression level in epithelial ovarian cancer was significantly lower than that of healthy controls and benign ovarian tumor group(P <0.05). Accorrding to ROC curve, the critical value of serum Smac is determined to be429.39 pmo/L. The Sensitivity of Smac single detection up to 91.67%, the specificity is 95%. The positive number of Smac inⅠ+Ⅱ phase was 14, the positive rate was 87.50%, the positive number of Smac in Ⅲ+Ⅳ phase was 41, the positive rate was93.18%, the difference was not statistically significant(P >0.05). Serum Smac was independent of age, pathological type,ascites, NLR and PLR, while it was associated with FIGO stage and lymph node metastasis. Smac expression level was higher than preoperative serum after the operation. The expression level of serum differences before and after the surgery were statistically significant(P=0.000), with the increase of number of chemotherapy, Smac level increased. Smac increased to normal at the end of the 2 period of chemotherapy. Conclusions:Serum Smac can be used to detect early ovarian cancer and may play an important role in differentiating benign and malignant ovarian tumors and monitoring the prognosis of postoperative ovarian cancer.