血清骨桥蛋白、胶质纤维酸性蛋白在脑胶质瘤诊断中的应用

Application of serum osteopontin and glial fibrillary acidic protein in the diagnosis of glioma

目的探讨血清骨桥蛋白(OPN)、胶质纤维酸性蛋白(GFAP)在脑胶质瘤诊断中的应用及与病理分级的关系。方法选取83例脑胶质瘤患者纳入脑胶质瘤组,另外选择颅内良性肿瘤患者20例纳入颅内良性肿瘤组,将体检的健康人群20例纳入对照组,所有纳入对象均接受血清OPN、GFAP水平检测。采用受试者工作特征(ROC)曲线评估血清指标对疾病的诊断价值,比较不同病理特征脑胶质瘤患者血清OPN、GFAP水平差异,分析血清指标与病理分级的关系,探讨患者治疗前后血清OPN、GFAP水平变化。结果脑胶质瘤组血清OPN、GFAP表达水平高于颅内良性肿瘤组和对照组,差异有统计学意义(P<0.05)。血清OPN、GFAP联合检测评估发生脑胶质瘤的ROC曲线下面积为0.883,高于OPN(0.793)、GFAP(0.789)单独检测(P<0.05)。不同性别、年龄、肿瘤位置、肿瘤直径、卡氏评分法(KPS)评分患者血清OPN、GFAP水平比较,差异无统计学意义(P>0.05);世界卫生组织(WHO)分级为Ⅲ~Ⅳ级、肿瘤抑制基因P53基因型突变型、细胞增殖活性抗原Ki-67高表达的脑胶质瘤患者血清OPN水平高于WHO分级为Ⅰ~Ⅱ级、P53基因型野生型、Ki-67低表达患者,GFAP水平低于WHO分级Ⅰ~Ⅱ级、P53基因型野生型、Ki-67低表达患者,差异有统计学意义(P<0.05)。联合检测诊断Ⅲ~Ⅳ级脑胶质瘤ROC曲线下面积为0.792,高于OPN(0.690)或GFAP(0.702)单独检测(P<0.05)。WHO分级为Ⅰ~Ⅱ级和Ⅲ~Ⅳ级脑胶质瘤患者术后第14天血清OPN、GFAP水平均较治疗前降低,且放化疗后患者血清OPN、GFAP水平进一步降低,差异有统计学意义(P<0.05);WHO分级为Ⅲ~Ⅳ级脑胶质瘤患者治疗前、术后2周、术后6个月的血清OPN、GFAP水平均高于Ⅰ~Ⅱ级患者,差异有统计学意义(P<0.05)。结论脑胶质瘤患者血清OPN、GFAP呈高表达,血清OPN高表达、GFAP低表达预示脑胶质瘤恶性程度高。

Objective To explore the application of serum osteopontin(OPN)and glial fibrillary acidic protein(GFAP)in the diagnosis of brain glioma and their relationships with pathological grade.Methods A total of 83 patients with brain glioma were included in brain glioma group.Another 20 patients with intracranial benign tumors were selected and included in intracranial benign tumor group,and 20 healthy people who underwent physical examinations were included in control group.All subjects were tested for serum OPN and GFAP levels.The diagnostic value of serum indexes for diseases was evaluated by receiver operating characteristic(ROC)curve.The differences of serum OPN and GFAP levels in patients with brain glioma with different pathological characteristics were compared,the relationship between serum indexes and pathological grade was analyze,and the changes of serum OPN and GFAP levels before and after treatment were explored.Results The expression levels of serum OPN and GFAP in the brain glioma group were higher than those in the intracranial benign tumor group and the control group(P<0.05);the area under ROC curve of the combined detection of serum OPN and GFAP was 0.883,which was higher than OPN(0.793),GFAP(0.789)alone(P<0.05).There were no significant differences in serum OPN and GFAP levels in different gender,age,tumor location,tumor diameter,Karnofsky Performance Status(KPS)score(P>0.05);the levels of serum OPN in brain glioma patients classified by World Health Organization(WHO)as gradeⅢtoⅣ,mutation of tumor suppressor gene P53 genotype and high expression of cell proliferative active antigen Ki-67 were higher than those in brain glioma patients classified by WHO as gradeⅠtoⅡ,wild-type P53 genotype and low expression of Ki-67(P<0.05).The area under ROC curve for diagnosis of gradeⅢtoⅣglioma by combined detection was 0.792,which was higher than OPN(0.690)or GFAP(0.702)alone(P<0.05).The serum levels of OPN and GFAP in WHO gradeⅠtoⅡandⅢtoⅣglioma patients on the 14th day after surgery were lower than those before treatment,and the serum levels of OPN and GFAP were further reduced after radiotherapy and chemotherapy,the differences were statistically significant(P<0.05).The levels of serum OPN and GFAP in patients with WHO gradeⅢtoⅣglioma before surgery,2 weeks after surgery and 6 months after surgery were higher than those in patients with gradeⅠtoⅡ(P<0.05).Conclusion Patients with brain glioma have high expression of serum OPN and GFAP,high expression of serum OPN and low expression of GFAP indicate high malignancy of glioma.