骨转换标志物与肿瘤标志物在骨转移诊断中的价值

The value of bone turnover biomarkers and tumor marker in the diagnosis of bone metastasis in breast cancer

目的探讨Ⅰ型胶原吡啶交联终肽(ICTP)、血清抗酒石酸盐酸性磷酸酶5b(Tracp 5b)联合CA15-3检测在乳腺癌骨转移中的诊断价值。方法采用回顾性研究,收集2009年9月至2012年8月于首都医科大学附属北京世纪坛医院乳腺科就诊的女性乳腺癌患者87例,根据骨转移情况分为骨转移组32例,无转移组35例,骨外转移组20例。并取同期收治的乳腺良性肿瘤患者25例为良性对照组应用酶联免疫吸附试验(ELISA)或化学发光免疫分析(CLISA)方法检测87例乳腺癌患者以及25例良性对照组患者的血清ICTP、Tracp 5b及CA15-3水平。结果血清ICTP、Tracp 5b和CA15-3水平在骨转移组显著升高(P<0.05)。ICTP、Tracp 5b、CA15-3平行联合检测诊断乳腺癌骨转移的敏感性、特异性、阳性预测值及阴性预测值分别为96.88%、76.36%、70.45%、97.67%。平行联合检测的敏感性较ICTP、Tracp 5b、CA15-3单独检测时显著提高,差异有统计学意义(P<0.05)。ICTP、Tracp 5b、CA15-3三项指标系列联合检测诊断乳腺癌骨转移的敏感性、特异性、阳性预测值及阴性预测值分别为37.50%、98.18%、92.31%、72.97%,系列联合检测的特异性较各指标单独检测时显著提高,差异有统计学意义(P<0.05)。联合诊断较三者独立诊断的效能高。结论血清ICTP、Tracp 5b联合CA15-3检测可显著提高乳腺癌骨转移的诊断效率,可作为辅助影像学诊断乳腺癌骨转移的有效实验室指标。

Objective To explore the diagnostic value of ICTP Tracp 5b and CA15-3 in bone metastasis of breast cancer.Method A retrospective review was performed in 87 breast cancer and 25 breast benign diseases the breast cancer patients were divided into 3 groups 32 patients with bone metastasis 35 patients with no metastasis and 20 patients with extraosseous metastasis.The serum levels of serum ICTP Tracp 5b and CA15-3 in 87 patients with breast cancer and 25 patients with benign tumor were measured by enzyme-linked immunosorbent assay ELISA and chemiluminescence immunoassay CLISA.Result The serum levels of ICTP Tracp 5b and CA15-3 were significantly increased in the bone metastasis group P<0.05.The sensitivity specificity positive predictive value and negative predictive value of the parallel combined detection of serum ICTP Tracp 5b and CA15-3 in the diagnosis of bone metastasis of breast cancer were 96.88%76.36%70.45%and 97.67%respectively.The sensitivity of parallel combined detection is significantly greater than ICTP Tracp 5b and CA15-3 P<0.05.The sensitivity specificity positive predictive value and negative predictive value of the parallel combined detection were 37.50%98.18%92.31%and 72.97%respectively.The specificity of parallel combined detection is significantly greater than ICTP Tracp 5b and CA15-3 P<0.05.Joint diagnosis is more effective than independent diagnosis of the three.Conclusion The detection of serum ICTP Tracp 5b and CA15-3 can significantly improve the diagnostic efficiency of bone metastasis in breast cancer and can be used as an effective laboratory index to assist imaging diagnosis of bone metastasis in breast cancer.