鼻咽癌患者的血清穿透素3水平及临床意义

Level and clinical significance of serum pentraxin 3 in patients with nasopharyngeal carcinoma

目的探讨鼻咽癌(NPC)患者的血清穿透素3(PTX3)水平及临床意义。方法选取本院2013年1月至2017年12月收治的105例NPC患者以及同期的113例健康体检者的血清标本为研究对象,采用酶联免疫吸附法(ELISA)测定上述标本的PTX3水平,受试者工作特征(ROC)曲线分析血清PTX3诊断NPC的效能和最佳诊断临界点,分析血清PTX3水平与NPC临床病理特征[性别、年龄、T分期、淋巴结转移、TNM分期、EB病毒DNA(EBV-DNA)载量、病理分级和分化程度]的关系;根据NPC患者的随访数据分析不同血清PTX3水平的预后情况,采用Cox比例风险回归模型进行多因素分析。结果ELISA检测结果显示105例NPC患者的血清PTX3水平为(18.761±7.986)mg/L,高于113例健康体检者的(5.365±3.165)mg/L,差异有统计学意义(P<0.05)。ROC曲线显示血清PTX3水平诊断NPC的曲线下面积为0.942(95%CI:0.909~0.974,P<0.001),以10.130 mg/L为界时对应的约登指数最大,敏感度和特异度分别为88.57%和98.23%。以105例NPC患者血清PTX3水平的均数为界分为低水平(≤18.761 mg/L)55例和高水平(>18.761 mg/L)50例,结果显示血清PTX3水平与NPC的T分期、淋巴结转移、TNM分期、EBV-DNA载量和分化程度有关(P<0.05),而与年龄、性别和病理分级无关(P>0.05)。全组随访15~60个月,中位随访45个月,中位总生存期(OS)为56.0个月,单因素分析显示T分期、淋巴结转移、TNM分期、病理分级、分化程度和血清PTX3水平与OS有关,其中PTX3低水平的中位OS>60.0个月,长于高水平的43.0个月(P<0.05),进一步多因素分析发现血清PTX3水平是影响NPC预后的独立因素(OR=2.715,95%CI:1.416~5.209,P=0.003)。结论NPC患者的血清PTX3水平升高,与NPC的临床分期和EBV感染有关,是影响NPC患者生存的独立危险因素。

Objective To investigate the level and clinical significance of serum pentraxin 3(PTX3)in patients with nasopharyngeal carcinoma(NPC).Methods The serum samples of 105 NPC patients admitted to our hospital from January 2013 to December 2017 and 113 healthy people at the same period were selected as the research objects.The PTX3 level was measured by enzyme-linked immunosorbent assay(ELISA).The receiver operating characteristic(ROC)curve was used to analyze the efficacy and the best diagnostic critical point of serum PTX3 in the diagnosis of NPC.The relationship between serum level of PTX3 and clinicopathological characteristics of NPC including gender,age,T stage,lymph node metastasis,TNM stage,Epstein-Barr virus(EBV)-DNA load,pathological grade and differentiation degree was analyzed.According to the follow-up data of NPC patients,the prognosis of different serum levels of PTX3 was analyzed,and Cox proportional risk regression model was used for multivariate analysis.Results The results of ELISA showed that the serum level of PTX3 in 105 NPC patients was(18.761±7.986)mg/L,higher than(5.365±3.165)mg/L in 113 healthy people(P<0.05).ROC curve showed that the area under the curve was 0.942(95%CI:0.909-0.974,P<0.001),and the yoden index was the highest when the corresponding threshold was 10.130 mg/L with the sensitivity of 88.57%and specificity of 98.23%.According to the mean of serum PTX3 level,105 NPC patients was divided into 55 cases with low level(≤18.761 mg/L)and 50 cases with high level(>18.761 mg/L).The results showed that serum PTX3 level was related to T stage,lymph node metastasis,TNM stage,EBV-DNA load and differentiation degree of NPC(P<0.05),but not to age,gender and pathological grade(P>0.05).The follow-up of the whole group was 15-60 months with the median follow-up of 45 months,and the median overall survival(OS)was 56.0 months.Univariate analysis showed that T stage,lymph node metastasis,TNM stage,pathological grade,differentiation degree and PTX3 level were related to OS.The median OS of low PTX3 level was more than 60.0 months,longer than 43.0 months of high PTX3 level(P<0.05).Further multivariate analysis found that serum PTX3 level was an independent risk factor for NPC patients(OR=2.715,95%CI:1.416-5.209,P=0.003).Conclusion The increased serum level of PTX3 in NPC patients is related to the clinical stage of NPC and EBV infection.It is an independent risk factor for NPC patients'survival.