磷脂酰肌醇蛋白聚糖1联合肿瘤标志物检测对胰腺癌的诊断价值

Study of diagnostic value of Glypican-1 combined with tumor markers in pancreatic cancer

目的探讨血清磷脂酰肌醇蛋白聚糖1(GPC-1)在胰腺癌中的表达及联合糖类抗原19-9(CA19-9)与癌胚抗原(CEA)对胰腺癌的诊断价值。方法招募2018年10月至2020年7月青岛市市立医院收治的胰腺癌患者60例,并选取同期就诊的胰腺良性病变患者31例、健康对照者50名,酶联免疫吸附试验检测血清GPC-1表达情况,免疫化学发光法检测血清CA19-9、CEA水平,采用受试者工作特征曲线(ROC)评价三者单独及联合检测对胰腺癌及血清学标志物阴性的胰腺癌的早期诊断价值。结果胰腺癌患者血清GPC-1表达水平与血管侵犯、胰管扩张、TNM分期、淋巴结和远处转移相关(均P<0.05)。血清GPC-1、CA19-9、CEA在胰腺癌中均呈高表达(P<0.05),单一指标诊断胰腺癌时,GPC-1的诊断价值高于CA19-9及CEA;在区分胰腺癌与健康对照、胰腺良性病变时,GPC-1+CA19-9、GPC-1+CEA或三者联合的曲线下面积(AUC)较单一指标明显增大,且三者联合诊断价值最高(AUC分别为0.916、0.870)。CA19-9、CEA单阴及双阴性的胰腺癌患者其GPC-1表达水平均高于健康对照者及胰腺良性病变患者,差异有统计学意义(P<0.05)。GPC-1在鉴别CA19-9、CEA单阴或双阴性的胰腺癌与健康对照、胰腺良性病变患者时,AUC为0.683-0.825,敏感度为71.4%-87.5%,特异度65.0%-82.9%,准确性73.9%-84.7%。结论胰腺癌中高表达的血清GPC-1与血管侵犯、胰管扩张、TNM分期、淋巴结和远处转移相关,血清GPC-1与CA19-9、CEA联合检测可提高胰腺癌的诊断价值,弥补传统单项血清学标志物检测的不足,是一种方便敏感的胰腺癌辅助筛查手段。

Objective To investigate the expression of serum Glypican-1(GPC-1)in pancreatic cancer and the diagnostic value of combined CA19-9 and CEA in pancreatic cancer.Methods Sixty patients with pancreatic cancer were recruited in Qingdao Municipal Hospital from October 2018 to July 2020,while thirty-one patients with benign pancreatic lesions and fifty healthy controls were selected in the same period.The expression of GPC-1 in serum was detected by ELISA.The levels of serum CA19-9 and CEA were detected by immunochemiluminescence assay,and the expression levels of serum GPC-1,CA19-9 and CEA were analyzed and compared.The receiver operating characteristic curve(ROC)was used to evaluate the early diagnostic value of GPC-1,CA19-9,CEA alone and in combination for pancreatic cancer and pancreatic cancer with negative serological markers.Results The expression level of serum GPC-1 in patients with pancreatic cancer was correlated with vascular invasion,pancreatic duct dilatation,TNM staging,lymph node and distant metastasis(all P<0.05).Serum GPC-1,CA19-9,and CEA were all highly expressed in pancreatic cancer(P<0.05).The diagnostic value of GPC-1 was higher than CA19-9 and CEA in the diagnosis of pancreatic cancer with a single index;when distinguishing pancreatic cancer from healthy control group and benign pancreatic lesions,GPC-1+CA19-9,GPC-1+CEA or their combination was significantly higher than any single index,with the highest diagnostic value(AUC was 0.916 and 0.870,respectively).The expression of GPC-1 in patients with single or double negative of CA19-9 and CEA was higher than that in healthy controls and patients with benign pancreatic lesions,the difference was statistically significant(P<0.05).When GPC-1 was used to distinguish the patients with single negative or double negative pancreatic cancer of CA19-9 and CEA,and healthy control and benign pancreatic lesions,the AUC was 0.683-0.825,the sensitivity was 71.4%-87.5%,the specificity was 65.0%-82.9%,the accuracy was 73.9%-84.7%.Conclusions The high expression of serum GPC-1 in pancreatic cancer is positively correlated with vascular invasion,pancreatic duct dilatation,TNM staging,lymph nodes and distant metastasis.The combined detection of serum GPC-1,CA19-9 and CEA can improve the diagnostic value of pancreatic cancer and make up for the deficiency of traditional single serological marker detection.It is a convenient and sensitive auxiliary screening method for pancreatic cancer.