血浆硫氧还蛋白还原酶在乳腺癌中表达及其临床价值研究

Study on the expression of plasma thioredoxin reductase in breast cancer and its clinical value

目的:研究血浆硫氧还蛋白还原酶(thioredoxin reductase,TrxR)在乳腺癌组织中的表达及其临床价值。方法:乳腺癌患者80例设为乳腺癌组,良性乳腺肿瘤患者48例设为良性对照组,50例健康体检人员设为正常对照组。采用酶联免疫吸附试验检测血浆TrxR水平,化学发光法检测血清癌抗原(carcinoma antigen 153,CA153)水平。比较3组血浆TrxR水平,分析TrxR水平与乳腺癌患者临床病理参数的关系,采用Spearman相关性分析血浆TrxR与血清CA153的相关性,受试者工作特征曲线(receiver operating characteristic curve,ROC)评估血浆TrxR、血清CA153对乳腺癌的诊断价值,比较乳腺癌患者治疗前后TrxR水平的变化。结果:乳腺癌组血浆TrxR水平明显高于良性对照组及正常对照组,良性对照组血浆TrxR水平明显高于正常对照组,差异均有统计学意义(P<0.05)。组织学分级Ⅱ~Ⅲ级乳腺癌患者血浆TrxR水平明显高于Ⅰ级患者,发生淋巴结转移患者血浆TrxR水平明显高于无淋巴结转移患者,TNM分期Ⅲ~Ⅳ期患者血浆TrxR水平明显高于Ⅰ~Ⅱ期患者,差异均有统计学意义(P<0.05)。Spearman相关性分析显示,血浆TrxR和血清CA153具有一定的相关性(r=0.3805,P<0.05)。ROC曲线分析显示,TrxR诊断乳腺癌的敏感度为84.0%,特异度为75.0%,曲线下面积(area under the curve,AUC)为0.8470;CA153诊断乳腺癌的敏感度为70.0%,特异度为77.5%,AUC为0.7815。72例Ⅰ~Ⅲ期乳腺癌患者接受手术治疗及术后辅助治疗,治疗后2个月乳腺癌患者TrxR水平较治疗前明显下降,差异有统计学意义(P<0.05)。结论:血浆TrxR可能成为有效的乳腺癌诊断指标,其在评估乳腺癌病情恶化程度、预测未来发展趋势等方面具有重要的临床意义。

Objective:To investigate the expression of plasma thioredoxin reductase(TrxR)in the breast cancer tissue and its clinical value.Methods:Eighty breast cancer patients were selected as the breast cancer group,48 patients with benign breast tumor were selected as the benign control group,and 50 healthy physical examination personnels were selected as the normal control group.Plasma TrxR and serum CA153 levels in each population group were detected by enzyme-linked immunosorbent assay(ELISA)and chemiluminescence assay respectively.Compare plasma TrxR level in the three groups.The relationship between plasma TrxR level and clinicopathological parameters of breast cancer patients was analyzed,and the relationship between plasma TrxR and serum CA153 was analyzed by Spearman.The diagnostic value of plasma TrxR and serum CA153 for breast cancer was analyzed by receiver operating characteristic curve(ROC).TrxR levels in breast cancer patients before and after treatment were determined and compared.Results:The plasma TrxR level in the breast cancer group was significantly higher than those in the benign and normal control groups(P<0.05).The plasma TrxR level in the benign control group was also significantly higher than that in the normal control group(P<0.05).The plasma TrxR level in the breast cancer patients with histological gradeⅡ~Ⅲwas higher than that in the patients with gradeⅠ;the plasma TrxR level in the breast cancer patients with lymph node metastasis was higher than that in the patients without lymph node metastasis;the plasma TrxR level in the breast cancer patients with TNM stageⅢ~Ⅳwas higher than that in the patients with stageⅠ~Ⅱ(P<0.05).The Spearman analysis showed that there was a correlation between plasma TrxR and serum CA153(r=0.3805,P<0.05).According to the ROC curve,the sensitivity of TrxR for the diagnosis of breast cancer was 84.0%,its specificity was 75.0%,and the area under the curve(AUC)was 0.8470.The sensitivity of CA153 for the diagnosis of breast cancer was 70.0%,its specificity was 77.5%,and AUC was 0.7815.Seventy-two breast cancer patients with stageⅠ~Ⅲunderwent surgical treatment and postoperative adjuvant therapy,and the TrxR level after two months of treatment decreased significantly compared with that before treatment(P<0.05).Conclusion:Plasma TrxR might be an effective diagnostic indicator of breast cancer with important clinical significance in evaluating the deterioration of breast cancer patients and in predicting its future development trend.