外泌体磷脂酰肌醇蛋白聚糖-1抗原对胰腺癌的诊断价值

Diagnostic value of glypican-1+crExos for pancreatic adenocarcinoma

目的探讨检测外周血中外泌体磷脂酰肌醇蛋白聚糖-1(GPC-1)抗原对术前协助诊断胰腺癌(PDAC)的应用价值。方法对2017年6月至2018年6月河北省人民医院31例PDAC患者(实验组)和22例慢性胰腺炎患者(对照组)的外周血,用超速离心机分离出外泌体,采用免疫组织化学链霉菌抗生物素蛋白-过氧化物酶(SP)法染色,流式细胞仪测定外泌体GPC-1的阳性率,同时采用电化学发光免疫分析法测定两组患者外周血糖类抗原19-9(CA19-9)含量。相关分析打用Person相关分析。结果GPC-1+外泌体在实验组的表达较对照组的表达率明显升高(27.52%比4.96%,Z=-5.145,P<0.01),差异有统计学意义;CA19-9在实验组的表达较对照组明显升高(176.40 mg/L比16.07 mg/L,Z=-3.342,P<0.05),差异有统计学意义。GPC-1+外泌体、CA19-9在受试者工作特征(ROC)曲线中的曲线下面积(AUC)分别为0.918、0.771(t=19.440,P<0.05),差异有统计学意义。外泌体GPC-1阳性率的约登指数为0.812,其GPC-1阳性率为12.16%,敏感度为90.30%,特异度为90.90%,误诊率为9.10%,漏诊率为9.70%。将CA19-9与GPC-1+外泌体联合用于PDAC的早期诊断时其ROC曲线下面积为0.922,95%可信区间为0.848~0.997,与GPC-1+外泌体独立诊断PDAC比较(ROC曲线下面积为0.918),差异无统计学意义(t=0.664,P>0.05)。结论外周血GPC-1+外泌体测定对临床上协助诊断PDAC的参考价值优于CA19-9,且不劣于两指标联合的诊断效率。

Objective To study the clinical value of elevated plasma glypican+exosomes in the diagnosis of pancreatic adenocarcinoma.Methods Peripheral blood from patients with pancreatic adenocarcinoma(study group)and chronic pancreatitis(control group)was extracted and exosomes were separated by ultracentrifuge.The content of phosphatidylinositol proteo glycan-1(GPC-1)was determined by immunohistochemical SP method.The basic principles were antigen-antibody reaction and chemical coloration.The content of plasma GPC-1+exosomes was determined by flow cytometry(FCM).Meanwhile,serum CA19-9 was determined by electrochemiluminescence immunoassay.Results Based on plasma CD82+exosomes,the positive rate of plasma GPC-1+exosomes was calculated.The expression of GPC-1 in plasma exosomes of study group was significantly higher than that in control group(27.52%vs.4.96%,Z=-5.145,P<0.01).The expression of CA19-9 in plasma of study group was also significantly higher than that in control group(176.40 vs.16.07 mg/L,Z=-3.342,P<0.05).The area under curve(AUC)of plasma GPC-1+exosomes and CA19-9 in receiver operating characteristic(ROC)curve was 0.918 and 0.771 respectively(t=19.440,P<0.05).The Yoden index of the positive rate of plasma GPC-1+exosomes was 0.812.The positive rate of plasma GPC-1+exosomes was 12.16%,the sensitivity was 90.30%,the specificity was 90.90%,the misdiagnosis rate was 9.10%,and the missed diagnosis rate was 9.70%.When CA19-9 and plasma GPC-1+exosomes were used in the diagnosis of pancreatic adenocarcinoma,the area under ROC curve was 0.922,and 95%confidence interval was 0.848-0.997,the difference was no statistically significant(0.922 vs.0.918,t=0.664,P>0.05).compared with plasma GPC-1+exosomes in the independent diagnosis of pancreatic adenocarcinoma.Conclusion The diagnostic value of elevated plasma GPC-1+exosomes in pancreatic adenocarcinoma is superior to that of CA19-9,and is not inferior to the diagnostic efficiency of the combination of the two indicators.