血清miR-144、CEA、CA724及CA125联合检测对早期胃癌的诊断价值

Value of Combined Detection of Serum miR-144,CEA,CA724 and CA125 in the Diagnosis of Early Gastric Cancer

目的研究血清微小核糖核酸-144(miR-144)、癌胚抗原(CEA)、糖链抗原724(CA724)、糖量抗原125(CA125)联合检测对早期胃癌的临床诊断价值。方法将收治的108例胃部病变患者纳为研究对象,采集其外周静脉血,检测血清miR-144、CEA、CA724及CA125水平,后经胃镜或手术病理活检证实其中59例为良性病变(44例为慢性非萎缩性胃炎、15例为慢性萎缩性胃炎),49例为早期胃癌(包括重度不典型增生),比较良性病变者与早期胃癌患者血清miR-144、CEA、CA724及CA125水平,绘制受试者工作特征曲线(ROC),分析以上指标单独及联合检测在诊断早期胃癌中的价值。结果恶性组患者血清miR-144水平低于良性组,血清CEA、CA724以及CA125水平高于良性组,差异具有统计学意义(P<0.05)。恶性组中,肿瘤不同位置患者血清miR-144、CEA、CA724、CA125水平比较,差异无统计学意义(P>0.05),未分化型患者血清miR-144水平低于分化型患者,血清CEA、CA724及CA125水平高于分化型患者,黏膜下层浸润患者miR-144水平低于黏膜内浸润者,血清CEA、CA724及CA125水平高于黏膜内浸润者,淋巴结转移患者血清miR-144水平低于无淋巴结转移者,血清CEA、CA724及CA125水平高于无淋巴结转移者,差异均具有统计学意义(P<0.05)。绘制ROC曲线发现,血清miR-144、CEA、CA724、CA125在诊断早期胃癌中的效能相似,但四者联合应用可有效提高各指标单独应用时的效能,联合预测因子在诊断早期胃癌中的AUC=0.894,95%CI为(0.837~0.951),灵敏度及特异度分别为83.7%与84.1%。结论各指标单独应用时,血清miR-144在诊断早期胃癌中的应用价值最高,而联合血清miR-144、CEA、CA724、CA125能有效提高各指标单独应用时的效能。

Objective To study the value of combined detection of serum microRNA-144(miR-144),carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724)and carbohydrate antigen 125(CA125)in the diagnosis of early gastric cancer.Methods 108 patients with gastric lesions were included.Fasting peripheral venous blood was collected and serum miR-144,CEA,CA724 and CA125 levels were measured.Endoscopic or surgical biopsy confirmed that 59 cases were benign lesions(44 cases of chronic non-atrophic gastritis and 15 cases of chronic atrophic gastritis)and 49 cases were early gastric cancer(including severe atypical hyperplasia).Serum levels of miR-144,CEA,CA724 and CA125 were compared between patients with benign lesions and patients with early gastric cancer,and receiver operating characteristic(ROC)curves were drawn to evaluate the value of separate and combined detection of the above indexes in diagnosing early gastric cancer.Results Serum miR-144 level of malignant group was lower than that of benign group,and serum CEA,CA724 and CA125 levels were higher than those of benign group,with statistical difference(P<0.05).Within malignant group,serum miR-144,CEA,CA724,and CA125 levels yielded no statistical difference among patients with different tumor locations(P>0.05).Serum level of miR-144 in undifferentiated patients was lower than that of differentiated patients,and serum CEA,CA724 and CA125 levels were higher than those of differentiated patients.Serum level of miR-144 in patients with submucosal infiltration was lower than that with intramucosal infiltration,and serum CEA,CA724 and CA125 levels were higher than those with intramucosal infiltration.Serum miR-144 level in patients with lymphatic metastasis was lower than that of patients without lymph node metastasis,and serum CEA,CA724 and CA125 levels were higher than those of patients without lymph node metastasis,with statistical difference(P<0.05).ROC curve found that serum miR-144,CEA,CA724,and CA125 had similar efficacy in diagnosing early gastric cancer.The efficacy of combined detection of the four indicators in diagnosing early gastric cancer was better than that of single detection[AUC=0.894,95%CI(0.837-0.951)],with sensitivity and specificity of 83.7%and 84.1%respectively.Conclusion In the separate test of miR-144,CEA,CA724 and CA125,miR-144 has the highest value in the diagnosis of early gastric cancer,while the combined detection of the four achieves higher diagnostic efficacy than separate detection.