mad2检测作为小细胞肺癌早期诊断潜在指标的临床研究

The clinical research about early diagnosis of small cell lung cancer through mad2 detection

目的:探讨有丝分裂阻滞缺陷蛋白基因2(mitotic arrest deficient 2,mad2)联合抗纺锤体抗体(anti-nuclear mitotic spindle apparatus antibody,MSA)和抗着丝点抗体(anti-centromere antibody,ACA)检测对诊断小细胞肺癌(small cell lung cancer,SCLC)的临床意义。方法:对120例SCLC、110例非小细胞肺癌(non-small cell lung cancer,NSCLC)患者和115例肺结节(pulmonary nodule,PN)患者用荧光定量PCR(qt-PCR)法检测mad2基因的表达,用间接免疫荧光法(indirect immunofluorescence assay,IFA)检测MSA,ACA的表达。结果:mad2基因在SCLC,NSCLC患者中均有表达;和NSCLC相比,mad2在SCLC中表达量更高(P<0.05);mad2诊断SCLC的ROC曲线下面积为0.799,诊断价值中等;相关性分析中MSA、ACA与SCLC的OR值分别为6.94和5.60;一致性分析中mad2基因联合MSA诊断的Kappa值为0.49;mad2联合ACA诊断的Kappa值0.42;并联分析诊断的敏感性为83.31%,特异性为79.34%,约登指数为0.62;串联分析诊断的敏感性为65.32%,特异性为93.35%,约登指数为0.59。结论:mad2在SCLC组中的表达量高于NSCLC组及肺结节组,在SCLC发生发展中起到重要作用;mad2检测联合MSA及ACA有助于提高诊断敏感性及特异性,对SCLC的早期检测、临床诊断及潜在的治疗方法有一定的应用价值。

Objective： To explore combined detection of mad2 with anti-nuclear mitotic spindle apparatus antibody （MSA） and anticentromere antibody （ACA） and their clinical value for the diagnosis of small cell lung cancer （SCLC）. Methods： One hundred and twenty SCLC patients, 110 non-small cell lung cancer （NSCLC） patients, and 225 pulmonary nodule （PN） patients were enrolled in this study. The expression of mad2 was analyzed by qt-PCR. MSA and ACA were detected by indirect immunofluorescence （IIF） staining. Results： mad2 was overexpressed in SCLC and NSCLC samples （P〈0.05）. There were significant differences between the results obtained for SCLC and NSCLC samples by qt-PCR （P〈0.05）. AUC in ROC curve for mad2 expression was 0.799 with an intermediate diagnostic value. In the correlative analysis, the odds ratio of MSA and ACA was 6.94 and 5.60, respectively. In the correlation analysis, Kappa value of mad2 with MSA was 0.49, and Kappa value of mad2 with ACA was 0.42. In the parallel analysis, the sensitivity and specificity was 83.31% and 79.34%, respectively, while the Youden Index was 0.62. Moreover, in the serial analysis, the sensitivity and specificity was 65.32% and 93.35%, respectively, and the Youden Index was 0.59. Conclusions： In comparison with the NSCLC and PN samples, mad2 was overexpressed in SCLC samples. Therefore, mad2 ought to play a critical role in the pathology of SCLC. The combined expression of mad2 with MSA and ACA may contribute to enhancing the sensitivity and specificity of detection; this expression may allow early diagnosis and clinical diagnosis of SLCC and may be a promising treatment for SCLC.