血清细胞角蛋白19片段、人附睾蛋白4、组织多肽特异性抗原水平及中性粒细胞与淋巴细胞比值与非小细胞肺癌患者的关系研究

Relations of Serum Levels of Cyfra21-1,HE4 and TPS,and Neutrophil to Lymphocyte Ratio to Non-small Cell Lung Cancer

背景寻找肺癌相关生物学标志物有助于肺癌的诊断及制定精准治疗策略。目的分析血清细胞角蛋白19片段(C yfra21-1)、人附睾蛋白4(HE4)、组织多肽特异性抗原(T PS)水平及中性粒细胞与淋巴细胞比值(N LR)与非小细胞肺癌(N SCLC)患者的关系。方法选取2014年2月2 017年12月西安交通大学医学院附属西安市中心医院收治的NSCLC患者92例作为试验组,另选取同期体检健康者100例作为对照组。比较两组受试者及不同TNM分期NSCLC患者血清Cyfra21-1、HE4、TPS水平及NLR,绘制ROC曲线以评价血清Cyfra21-1、HE4、TPS水平及NLR对NSCLC的诊断价值;绘制Kaplan-Meier生存曲线以评价不同血清Cyfra21-1、HE4、TPS水平及NLR的NSCLC患者生存状况。结果(1)试验组患者血清Cyfra21-1、HE4、TPS水平及NLR高于对照组(P<0.05)。(2)TNM分期Ⅲ、Ⅳ期患者血清Cyfra21-1、HE4、TPS水平及NLR高于Ⅰ~Ⅱ期患者,T NM分期Ⅳ期患者血清Cyfra21-1、HE4、TPS水平及NLR高于Ⅲ期患者(P<0.05)。(3)ROC曲线显示,血清Cyfra21-1、HE4、TPS水平及NLR诊断NSCLC的曲线下面积(A UC)分别为0.609[95%CI(0.708,0.983)]、0.673[95%CI(0.549,0.796)]、0.760[9 5%CI(0.649,0.870)]及0.809[95%CI(0.795,0.952)],四者联合诊断NSCLC的AUC为0.876[95%CI(0.801,0.951)]。(4)Kaplan-Meier生存曲线显示,C yfra21-1、HE4、TPS、NLR阳性NSCLC患者1、3、5年生存率分别低于Cyfra21-1、HE4、TPS、NLR阴性患者(P<0.05)。结论血清Cyfra21-1、HE4、TPS水平及NLR随NSCLC患者TNM分期增加而升高,血清TPS水平、N LR及四者联合对NSCLC具有一定诊断价值,且血清Cyfra21-1水平>5μg/L、血清HE4水平>70 pmol/L、血清TPS水平>80 U/L及NLR>2的NSCLC患者预后较差。

Background Finding biomarkers related to lung cancer is helpful for the diagnosis and precise treatment of lung cancer.Objective To analyze the relations of serum levels of Cyfra21-1,HE4 and TPS,and neutrophil to lymphocyte ratio(NLR)to non-small cell lung cancer(NSCLC).Methods From February 2014 to December 2017,a total of 92 patients with NSCLC were selected as test group in Xi'an Central Hospital,School of Medicine,Xi'an Jiaotong University,meanwhile 100 healthy volunteers visited this hospital for physical examination were selected as control group.Serum levels of Cyfra21-1,HE4 and TPS,and NLR were compared between the two groups and in NSCLC patients with different TNM stages;ROC curve was drawn to evaluate the diagnostic value of serum levels of Cyfra21-1,HE4 and TPS,and NLR on NSCLC;Kaplan-Meier survival curve was drawn to evaluate the survival status in NSCLC patients with different serum levels of Cyfra21-1,HE4 and TPS,and NLR.Results(1)Serum levels of Cyfra21-1,HE4 and TPS,and NLR in test group were statistically significantly higher than those in control group(P<0.05).(2)Serum levels of Cyfra21-1,HE4 and TPS,and NLR in NSCLC patients withⅢ-andⅣ-TNM stages were statistically significantly higher than those in NSCLC patients withⅠ-ⅡTNM stage,meanwhile serum levels of Cyfra21-1,HE4 and TPS,and NLR in NSCLC patients withⅣ-TNM stage were statistically significantly higher than those in NSCLC patients withⅢ-TNM stage(P<0.05).(3)ROC curve showed that,AUC of serum levels of Cyfra21-1,HE4 and TPS,and NLR was 0.609〔95%CI(0.708,0.983)〕,0.673〔95%CI(0.549,0.796)〕,0.760〔95%CI(0.649,0.870)〕and 0.809〔95%CI(0.795,0.952)〕,respectively,and that of the combination of the above four was 0.876〔95%CI(0.801,0.951)〕.(4)Kaplan-Meier survival curve showed that,the 1-,3-and 5-year survival rate in NSCLC patients with positive Cyfra21-1,HE4,TPS and NLR was statistically significantly lower than that in NSCLC patients with negative Cyfra21-1,HE4,TPS and NLR,respectively(P<0.05).Conclusion Serum levels of Cyfra21-1,HE4 and TPS,and NLR increase with the increase of TNM stage in NSCLC patients;serum TPS level,NLR and combination of the above four have diagnostic value on NSCLC to some extent;prognosis is relatively poor in NSCLC patients with serum Cyfra21-1 level>5μg/L,serum HE4 level>70 pmol/L,serum TPS level>80 U/L and NLR>2.