miR-21联合CA19-9检测诊断胰腺癌临床价值分析

The clinical value of miR-21 combined with CA19-9 in the diagnosis of pancreatic cancer

目的探究微RNA 21(miR-21)联合糖类抗原19-9(CA19-9)检测诊断胰腺癌的临床价值。方法回顾性选择2013年2月至2017年10月间于宜兴市人民医院和中国人民解放军第四一一医院确诊的胰腺癌患者66例(胰腺癌组),并选择同时期、同年龄段的良性胰腺疾病患者66例(良性疾病组)以及健康体检者66例(对照组)。比较三组患者miR-21和CA19-9的水平差异,并以临床诊断作为金标准,绘制受试者工作曲线(ROC)并评价miR-21和CA19-9单独和联合诊断胰腺癌的诊断效能(包括诊断准确率、敏感度、特异度、阳性预测值和阴性预测值等)。结果三组患者的miR-21和CA19-9水平间有显著的统计学差异(P<0.05);其中,胰腺癌组患者的miR-21和CA19-9水平均显著高于对照组和良性疾病组,差异均有统计学意义(P<0.05)。ROC曲线显示,miR-21和CA19-9联合诊断胰腺癌的曲线下面积(AUC)显著高于miR-21和CA19-9,其中,miR-21的最佳截点为5.78×10~5拷贝/μl,CA19-9的最佳截点为46.85 U/L。应用上述最佳截点,miR-21和CA19-9联合诊断胰腺癌的敏感度和阳性预测值均明显高于miR-21和CA19-9单独诊断(P<0.05)。结论 miR-21联合CA19-9检测诊断胰腺癌具有较高价值,其中miR-21≥5.78×105拷贝/μl和/或CA19-9≥46.85 U/L可以作为胰腺癌筛查的最佳截点。

Objective To explore the clinical value of miR-21combined with CA19-9in the diagnosis of pancreatic cancer.Methods66patients with pancreatic cancer from February2013to October2017diagnosed in our hospital and People's Liberation Army411Hospital(pancreatic cancer group),66patients with benign pancreatic disease(benign disease group)and66cases of healthy subjects(control group)with the same period and the age were selected,miR-21and CA19-9level in the three groups were comparatively analyzed.Using the clinical diagnosis as the gold standard,receiver operating curve(receiver operating characteristic curve,ROC)was drawn and the diagnostic efficacy of miR-21and of CA19-9alone and combination in the diagnosis of pancreatic cancer were evaluated(including diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value etc.).Results There was a statistically significant difference in levels of miR-21and CA19-9in the three groups(P<0.05).Among them,miR-21and CA19-9level of pancreatic cancer patients were significantly higher than those in control group and benign group(P<0.05).The ROC curve showed that the combination of miR-21and CA19-9(AUC=0.907,95%CI0.853~0.960)in the diagnosis of pancreatic carcinoma was significantly higher than that of miR-21and CA19-9,the optimal cut-off value of miR-21was5.78×105copies/μl,CA19-946.85U/L.Using the above cut-off values,the sensitivity and positive predictive value of miR-21combined with CA19-9in the diagnosis of pancreatic cancer were significantly higher than those of miR-21and CA19-9alone(P<0.05).Conclusion miR-21combined with CA19-9have a higher value in the diagnosis of pancreatic cancer,wherein miR-21≥55.78×105copies/μl,CA19-9≥46.85U/L can be regarded as the best cut-off value for pancreatic cancer screening.