联合检测APOB和CYFRA21-1在乳腺癌筛查中的临床意义

Clinical Significances of Combined Detection of APOB and CYFRA21-1 in Breast Cancer Screening

目的探讨载脂蛋白B(apolipoproteins B,APOB)和细胞角蛋白19片断(cytokeratin-19-fragment,CYFRA21-1)在乳腺癌早期筛查中的意义。方法收集2018年1月至2020年10月在解放军总医院第一医学中心确诊为原发性乳腺癌的患者(109例)、以及年龄匹配的乳腺良性病患者(98例)和健康对照(193例)的临床资料,对其血脂水平及肿瘤标志物等检查结果进行统计学分析。结果单因素统计分析显示,乳腺癌患者总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein,LDL)、APOB水平显著低于乳腺良性病组(P<0.05)和健康对照组(P<0.05),其CYFRA21-1水平显著高于乳腺良性病组(P<0.05)和健康对照组(P<0.05)。二元Logistic回归分析结果显示,APOB是乳腺癌的保护因素、CYFRA21-1是乳腺癌发生的独立危险因素(P<0.05),APOB每增加一个单位,乳腺良性病患者患有乳腺癌的概率将降低96%(P<0.05);CYFRA21-1每增加一个单位,乳腺良性病患者发生癌症的概率增加0.79倍(P<0.05)。APOB、CYFRA21-1及其联合检测的ROC曲线下面积(AUC)分别为0.681、0.660及0.714,其中APOB和CYFRA21-1联合诊断鉴别乳腺良性病及乳腺癌的概率最高,其灵敏度和特异性分别为79.8%和65.7%,95%可信区间(95%CI)为0.629~0.798。结论联合检测血清中的APOB和CYFRA21-1,可以作为鉴别乳腺癌及乳腺良性病的早期筛查指标。

Objective To explore the significance of Apolipoproteins B(APOB)and Cytokeratin-19-fragment(CYFRA21-1)in breast cancer screening.Methods We collected clinical data of 109 patients diagnosed with primary breast cancer,98 patients with benign breast disease,and 193 healthy controls from January,2018 to October,2020 in the First Medical Center of PLA General Hospital.All patients’blood lipids and tumor markers were examined.The results were then analyzed statistically.Results Univariate analysis showed that the levels of total cholesterol(TC),low density lipoprotein cholesterol(LDL)and APOB in breast cancer patients were significantly lower than those in the benign breast disease group(P<0.05)and the healthy control group(P<0.05),while their CYFRA21-1 level was significantly higher than that in the benign breast disease group(P<0.05)and healthy control group(P<0.05).Binary logistic regression analysis showed that APOB was a protective factor of breast cancer,and CYFRA21-1 was an independent risk factor of breast cancer(P<0.05).For each unit of APOB increase,the probability of breast cancer in patients with benign breast disease was reduced by 96%.The probability of cancer in patients with benign breast disease increased by 0.79 times(P<0.05)with each unit of CYFRA21-1 increased.The area under the ROC curve(AUC)of APOB,CYFRA21-1 and their combinations were 0.681,0.660 and 0.714,respectively.APOB and CYFRA21-1 combined diagnosis had the highest probability of identifying benign breast disease and cancer,and their sensitivity and specificity were 79.8%and 65.7%,respectively,with 95%confidence interval(95%CI)of 0.629 to 0.798.Conclusion The combination of APOB and CYFRA21-1 can be used as an early screening index to identify breast cancer and benign breast diseases.