基质金属蛋白酶3在良恶性胸腹水鉴别诊断中的临床价值

Clinical value of differential diagnosis of matrix metalloproteinase-3 in benign and malignant hydrothorax and ascites

目的探讨胸腹水中基质金属蛋白酶3(MMP-3)、腺苷脱氨酶(ADA)和乳酸脱氢酶(LDH)的水平,评估其指标联合检测在良性和恶性胸腹水中的应用价值。方法病例对照研究。选取2018年8月至2019年7月在湖南中医药大学第一附属医院住院治疗的278例胸腹水患者为研究对象,检测其胸腹水中MMP-3、ADA和LDH的水平,分析良性组(208例患者)和恶性组(70例患者)胸腹水MMP-3、ADA、LDH的检测值、受试者工作特性(ROC)曲线、敏感度和特异度,并对结果进行综合比较。结果(1)良性组胸水MMP-3水平为(89.21±61.93)ng/mL,ADA水平为(9.08±8.89)U/L,LDH水平为(143.34±68.63)U/L,恶性组胸水MMP-3水平为(205.63±98.16)ng/mL,ADA水平为(10.96±5.04)U/L,LDH水平为(243.44±131.20)U/L,良性组腹水MMP-3水平为(84.91±73.48)ng/mL,ADA水平为(3.48±2.80)U/L,LDH水平为(99.48±69.53)U/L,恶性组腹水MMP-3水平为(174.89±82.48)ng/mL,ADA水平为(6.31±4.42)U/L,LDH水平为(0191.86±94.52)U/L,恶性组胸水、腹水MMP-3、ADA、LDH水平均高于良性组,差异有统计学意义(Z1值分别为5.215、2.549、3.212,Z2值分别为6.188、4.524、6.38,P1和P2均<0.05)。(2)MMP-3诊断肺癌胸水、肝癌腹水和胃癌腹水的曲线下面积(AUC)分别为0.853、0.826、0.763,敏感度分别为76%、96.9%、92.3%,特异度分别为80%、64.5%、61.6%。MMP-3对肺癌胸水、肝癌腹水的诊断效能均高于ADA(AUC分别为0.672、0.691)和LDH(AUC分别为0.717、0.804),而对胃癌腹水的诊断效能低于ADA(AUC为0.808)和LDH(AUC为0.849),以LDH最佳。(3)MMP-3、ADA、LDH指标联合诊断肺癌胸水、肝癌腹水和胃癌腹水的AUC分别为0.861、0.842、0.879,敏感度分别为64%、96.9%、84.6%,特异度分别为92.9%、63.8%、80.4%。在肺癌胸水、肝癌腹水和胃癌腹水中,三项联合检测的诊断效能均优于MMP-3和LDH联合检测(AUC分别为0.86、0.839、0.872)、MMP-3和ADA联合检测(AUC分别为0.845、0.831、0.855)、LDH和ADA联合检测(AUC分别为0.713、0.791、0.846)。结论MMP-3对良性和恶性胸腹水鉴别诊断有重要意义,可能作为良性和恶性胸腹水鉴别诊断的重要指标之一,MMP-3分别与ADA和LDH联合检测和三项联合检测的诊断效能优于单项指标,对于鉴别诊断良性和恶性胸腹水有一定的临床价值。

ObjectiveTo investigate the levels of matrix metalloproteinases-3(MMP-3),adenosine deaminase(ADA)and lactate dehydrogenase(LDH)in the hydrothorax and ascites,and to approach the diagnostic value of three combined indexes in benign and malignant hydrothorax and ascites.MethodsCase-control study.A total of 278 patients with hydrothorax and ascites were enrolled in this study who were hospitalized in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from August 2018 to July 2019 to detect the levels of MMP-3,ADA and LDH in the hydrothorax and ascites.The benign group(208 patients)and malignant group(70 patients)were compared with MMP-3,ADA,LDH,receiver operating characteristic(ROC)curve,sensitivity and specificity in the hydrothorax and ascites,and the results were compared comprehensively.Results(1)The MMP-3 level in the benign hydrothorax group was 89.21±61.93 ng/mL,the ADA level was(9.08±8.89)U/L,the LDH level was(143.34±68.63)U/L,and the MMP-3 level in the malignant hydrothorax group was(205.63±98.16)ng/mL,he ADA level was(10.96±5.04)U/L,the LDH level was(243.44±131.20)U/L.The MMP-3 level in the benign ascites group was(84.91±73.48)ng/mL,the ADA level was(3.48±2.80)U/L,the LDH level was(99.48±69.53)U/L,and the MMP-3 level in the malignant ascites group was(174.89±82.48)ng/mL,the ADA level was(6.31±4.42)U/L,the LDH level was(191.86±94.52)U/L.The levels of MMP-3,ADA and LDH in the hydrothorax and ascites of the malignant group were higher than those in the benign group,and the difference was statistically significant(Z1 values were 5.215,2.549,3.212,respectively,and Z2 values were 6.188,4.524,6.38,respectively,P1 and P2 were<0.05).(2)The area under the curve(AUC)of MMP-3 for diagnosis of hydrothorax,liver cancer ascites and gastric cancer ascites was 0.853,0.826,and 0.763,respectively.The sensitivity was 76%,96.9%,and 92.3%,respectively,and the specificity was 80%,64.5%,61.6%.The diagnostic efficacy of MMP-3 in lung cancer hydrothorax and liver cancer ascites was higher than ADA(AUC were 0.672,0.691,respectively)and LDH(AUC were 0.717,0.804,respectively),and the diagnostic efficacy of gastric cancer ascites was lower than ADA(AUC is 0.808)and LDH(AUC is 0.849),and LDH was the best.(3)The AUC of MMP-3,ADA and LDH combined diagnosis of lung cancer hydrothorax,liver cancer ascites and gastric cancer ascites were 0.861,0.842,and 0.879,respectively.The sensitivities were 64%,96.9%,and 84.6%,respectively,and the specificities were 92.9%,63.8%,and 80.4%,respectively.In the lung cancer hydrothorax,liver cancer ascites and gastric cancer ascites,the combined efficacy of the three combined tests was better than the combined detection of MMP-3 and LDH(AUC were 0.86,0.839,0.872,respectively),combined detection of MMP-3 and ADA(AUC were 0.845,0.831,0.855,respectively),LDH and ADA combined detection(AUC were 0.713,0.791,0.846,respectively).ConclusionsMMP-3 is important for the differential diagnosis of benign and malignant hydrothorax and ascites,and may be one of the important indicators for the differential diagnosis of benign and malignant hydrothorax and ascites.The diagnostic efficacy of MMP-3 combined with ADA and LDH and three combined detection is better than single index,which has certain clinical value for differential diagnosis of benign and malignant hydrothorax and ascites.