TAP和Hsp90ɑ检测在肺癌恶性胸腔积液诊断及预后评估的价值

Diagnostic and prognostic value of TAP and Hsp90ɑin lung cancer complicated with malignant pleural effusions

目的探讨TAP和Hsp90ɑ检测,对肺癌恶性胸腔积液诊断及预后预测的临床价值。方法选取2019年2月-2020年12月收治我科胸腔积液和肺部占位的患者,经支气管镜、经皮肺穿刺活检术和胸腔积液脱落细胞学等检查,诊断恶性胸腔积液和肺癌。用ELISA法测定外周血和胸腔积液中TAP和Hsp90ɑ的表达,比较各组中的表达差异,并通过绘制ROC曲线图评估TAP和Hsp90ɑ的诊断价值。随访1年,采用COX回归分析TAP和Hsp90ɑ对肺癌恶性胸腔积液患者生存期的影响。结果纳入良性胸腔积液组19例,肺癌恶性胸腔积液组18例,中晚期肺癌组17例。ROC曲线显示,检测外周血中TAP、Hsp90ɑ(RR分别为3.294、4.533,AUC分别为0.833、0.795)和胸腔积液中TAP、Hsp90ɑ(RR分别为3.560,3.178;AUC分别为0.86、0.819)对肺癌恶性胸腔积液均有一定诊断价值(P<0.05);胸腔积液中TAP和Hsp90ɑ联合检测的诊断价值(AUC=0.974)大于二者在外周血中的联合检测价值(AUC=0.915),且大于TAP、Hsp90ɑ在外周血或胸腔积液中单项检测的诊断价值;因此,可认为胸腔积液中TAP和Hsp90ɑ联合检测的诊断效能可能更优(P<0.05)。COX回归分析显示TAP和Hsp90ɑ对肺癌恶性胸腔积液患者预后有显著影响,且二者均为独立危险因素(TAP 95%CI为1.755~50.96,Hsp90ɑ95%CI为1.666~54.179);TAP和Hsp90ɑ表达量越高,生存期越短,预后愈差。结论TAP和Hsp90ɑ在肺癌恶性胸腔积液诊断中均具有临床应用价值,二者联合诊断效能更优,对患者预后有一定的评估价值。

Objective To investigate the diagnostic and prognostic value of TAP and Hsp90ɑin lung cancer complicated with malignant pleural effusion(MPE).Methods Patients with pleural effusion and lung occupation admitted to our department from February 2019 to December 2020 were prospectively recruited.MPE and lung cancer were confirmed by bronchoscopy,percutaneous lung biopsy and pleural effusion cytology.The expressions of TAP and Hsp90ɑin peripheral blood and pleural effusion were determined by ELISA.The expression differences among the groups were compared and the diagnostic value of TAP and Hsp90ɑwas evaluated by ROC curve drawing.After one year of follow-up,COX regression analysis was performed to analyze the effects of TAP and Hsp90ɑon the survival of lung cancer patients with MPE.Results A total of 19 cases of pleural effusion group,18 cases of malignant pleural effusion,17 cases of advanced lung cancer group were included.The ROC curve showed that the detection of TAP and Hsp90ɑin peripheral blood(RR 3.294 and 4.533;AUC 0.833 and 0.795,respectively)and TAP and Hsp90ɑin pleural effusion(RR 3.560 and 3.178;AUC were 0.86 and 0.819,respectively)had certain diagnostic value for MPE of lung cancer(P<0.05).The diagnostic value of the combined detection of TAP and Hsp90ɑin pleural effusion(AUC=0.974)was greater than the combined detection value of the two in peripheral blood(AUC=0.915),and greater than that of TAP and Hsp90ɑin the single detection of peripheral blood or pleural effusion;Therefore,it could be considered that the diagnostic performance of the combined detection of TAP and Hsp90ɑin pleural effusion might be better(P<0.05).COX regression analysis showed that TAP and Hsp90ɑhad significant effects on the prognosis of lung cancer patients with MPEand both were independent risk factors(TAP 95%CI:1.755~50.96,Hsp90ɑ95%CI:1.666~54.179);The higher the expression levels of TAP and Hsp90ɑ,the shorter the survival period and the worse the prognosis.Conclusion Both TAP and Hsp90ɑhave clinical application value in the diagnosis of MPE in lung cancer.The combination of the two has better diagnostic performance and has a certain value in evaluating the prognosis of patients.