皮肌炎和系统性硬化患者血清肿瘤标志物水平及差异分析

Analysis of serum tumor markers levels in dermatomyositis and systemic sclerosis patients

目的检测皮肌炎和系统性硬化患者血清的肿瘤标志物水平,并分析两组患者的差异。方法选择2017年5月至2022年5月由唐都医院收治的女性皮肌炎患者123例及女性系统性硬化患者70例。采集皮肌炎及系统性硬化患者血液,利用化学发光法检测糖类抗原724(carbohydrate antigen 724,CA724)、甲胎蛋白(alpha-fetoprotein,AFP)、铁蛋白(ferritin,FRT)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、糖类抗原199(carbohydrate antigen 199,CA19-9)、糖类抗原125(carbohydrate antigen 125,CA125)、细胞角蛋白19片段(cytokeratin-19-fragment,CYFRA21-1)、糖类抗原153(carbohydrate antigen 153,CA153)、β人绒毛膜促性腺激素(β human chorionic gonadotropin,β-HCG)、附睾蛋白4(human epididymal protein 4,HE4)、糖类抗原50(carbohydrate antigen 50,CA50)、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCC)水平。比较分析两组患者的肿瘤标志物水平差异及肿瘤标志物阳性率差异。结果皮肌炎患者的CA724、AFP、FRT及NSE水平显著高于系统性硬化患者,CA125和HE4水平显著低于系统性硬化患者,差异有统计学意义[U/mL:2.34(1.50~8.45)比1.53(0.97~3.55),ng/mL:2.53(1.92~3.95)比2.21(1.61~2.86),μg/L:188.80(81.65~477.70)比88.93(44.54~174.22),ng/mL:13.60(11.04~19.23)比12.75(10.31~14.55),U/mL:13.78(8.12~24.79)比16.94(9.39~51.56),pmol/L:91.12(61.65~131.10)比114.25(75.98~174.15),w=3104.5、3336.5、2895、3537、5144.5、5147.5,P值均<0.05]。两组患者血清中CA19-9、CYFRA21-1、CA153、β-HCG、SCC及CA50表达水平差异均无统计学意义(P>0.05)。两组患者的阳性率比较结果显示,皮肌炎患者CA724及NSE的阳性率显著高于系统性硬化患者,而CA125的阳性率则显著低于系统性硬化患者,差异有统计学意义(30.08%比11.43%),(33.33%比17.14%),(16.26%比32.86%),χ2=7.669、5.086、6.171,P值均<0.05。此外,83.74%皮肌炎和80%系统性硬化患者具有≥1种肿瘤标志物的升高现象。Spearman相关性分析结果显示,皮肌炎患者肿瘤标志物AFP与β-HCG,HE4分别与FRT、CA125、CYFRA21-1、CA153,CA19-9与CA50均成显著正相关(r=0.420、0.453、0.443、0.631、0.433、0.773,P值均<0.05)。系统性硬化患者肿瘤标志物CA19-9与CA50,HE4分别与CA125、CYFRA21-1、CA153均成显著正相关(r=0.849、0.483、0.638、0.406,P值均<0.05)。结论皮肌炎和系统性硬化患者血清中存在多种肿瘤标志物水平升高现象,且两组患者肿瘤标志物升高的程度和升高的肿瘤标志物种类存在显著差异。

Objective To analyze the levels and difference of serum tumor markers in dermatomyositis and systemic sclerosis patients.Methods Total of 123 female patients with dermatomyositis and 70 female patients with systemic sclerosis admitted by Tangdu Hospital from May 2017 to May 2022 were selected.Blood samples were collected from dermatomyositis and systemic sclerosis patients.The chemiluminescence immunoassay assay was used to detect the levels of carbohydrate antigen 724(CA724),alpha fetoprotein(AFP),ferritin(FRT),neuron specific enolase(NSE),carbohydrate antigen 199(CA19-9),carbohydrate antigen 125(CA125)cytokeratin-19-fragment(CYFRA21-1),carbohydrate antigen 153(CA153),βhuman chorionic gonadotropin(β-HCG),human epididymal protein 4(HE4),carbohydrate antigen 50(CA50),and squamous cell carcinoma antigen(SCC).The levels and positive rate of tumor markers between dermatomyositis and systemic sclerosis were compared.Results The levels of CA724,AFP,FRT and NSE in patients with dermatomyositis were significantly higher than those in patients with systemic sclerosis,and the levels of CA125 and HE4 were significantly lower than those in patients with systemic sclerosis[U/mL:2.34(1.50~8.45)vs 1.53(0.97~3.55),ng/mL:2.53(1.92~3.95)vs 2.21(1.61~2.86),μg/L:188.80(81.65~477.70)vs 88.93(44.54~174.22),ng/mL:13.60(11.04~19.23)vs 12.75(10.31~14.55),U/mL:13.78(8.12~24.79)vs 16.94(9.39~51.56),pmol/L:91.12(61.65~131.10)vs 114.25(75.98~174.15),w=3104.5,3336.5,2895,3537,5144.5,5147.5,all P values<0.05].There were no statistically significant differences in the expression levels of CA19-9,CYFRA21-1,CA153,β-HCG,SCC,and CA50 between the two groups(P>0.05).The comparison of positive rates between the two groups showed that the positive rates of CA724 and NSE in patients with dermatomyositis were significantly higher than those in patients with systemic sclerosis,while the positive rates of CA125 were significantly lower than those in patients with systemic sclerosis(30.08%vs 11.43%),(33.33%vs 17.14%),(16.26%vs 32.86%),χ2=7.669,5.086,6.171,all P values<0.05.In addition,83.74%of patients with dermatomyositis and 80%of patients with systemic sclerosis had an increase of≥1 tumor markers.Spearman correlation analysis showed that AFP was significantly positively correlated withβ-HCG,HE4 was positively correlated with FRT,CA125,CYFRA21-1 and CA153 respectively,and CA19-9 was positively correlated with CA50 in dermatomyositis patients(r=0.420、0.453、0.443、0.631、0.433、0.773,all P values<0.05).CA19-9 was significantly positively correlated with CA50,and HE4 was positively correlated with CA125,CYFRA21-1 and CA153 respectively in systemic sclerosis patients(r=0.849,0.483,0.638,0.406,all P values<0.05).Conclusion The levels of tumor markers in most of dermatomyositis and systemic sclerosis patients are elevated.There are significant differences between the two groups in the extent and types of tumor markers.