血清ALP、PINP、PTHrP对肺癌骨转移诊断的价值-东南大学学报医学版

血清ALP、PINP、PTHrP对肺癌骨转移诊断的价值

单位：1. 南京大学医学院附属南京鼓楼医院普内科, 江苏南京 210008;
2. 南京大学医学院附属南京鼓楼医院肿瘤中心, 江苏南京 210008

分类号：R734.2

出版年·卷·期（页码）：2020·39·第三期（309-314）

摘要：

目的:探讨骨代谢生化标志物与骨转移癌进展程度的相关性,旨在早期判断肺癌骨转移的发生。方法:选取2010年9月至2011年9月在南京鼓楼医院就诊的88例肺癌患者。所有患者均经组织病理证实为肺癌,骨转移的发生经患者临床表现、ECT及CT证实。酶联免疫吸附试验(ELISA)检测血清Ⅰ型前胶原氨基端前肽(PINP)及甲状旁腺激素相关蛋白(PTHrP)的表达水平,化学发光方法检测碱性磷酸酶(ALP)、血清肿瘤标志物CEA、CA125、CYFRA21-1及NSE表达水平。比较ECT全身骨显像诊断为骨转移和非骨转移两组患者中ALP、PINP、PTHrP、CEA、CA125、CYFRA21-1及NSE的血清水平。结果:血清ALP的受试者工作特征曲线下面积为0.646,敏感度及特异度分别为51.2%及82.6%。PINP的曲线下面积为0.844,敏感度及特异度分别为73.2%及87%。PTHrP的曲线下面积为0.791,敏感度及特异度分别为78%及67.4%。PINP对于肺癌骨转移的预测具有较高的诊断价值。ALP、PINP及PTHrP的联合应用诊断肺癌骨转移的曲线下面积为0.903,诊断敏感度及特异度分别为85.4%及89.1%,具有更高的诊断效率。此外血清肿瘤标志物中CEA、CA125及CYFRA21-1的联合诊断曲线下面积为0.702,诊断价值弱于ALP、PINP及PTHrP的联合应用。结论:通过检测ALP、PINP、PTHrP有助于早期诊断肺癌骨转移的发生,指标联合诊断的效能更高。

Objective:To explore the correlation between bone metabolism biochemical markers and bone metastasis in cancer patients, and help to determine the occurrence of bone metastasis in lung cancer early. Methods:From September 2010 to September 2011, 88 patients with lung cancer were treated in Nanjing Drum Tower Hospital, who were confirmed to be lung cancer by histopathological pathology, and the occurrence of bone metastasis was demonstrated by clinical syndrome, ECT and CT. The expression level of serum PINP and PTHrP were detected by enzyme-linked immunosorption test (ELISA). The expression levels of ALP, CEA, CA125, CYFRA21-1 and NSE were quantitatively detected by chemiluminescent immunoassay. We collected and compared the level of serum PINP, PTHrP, ALP, CEA, CA125, CYFRA21-1 and NSE in bone metastasis and non-metastasis lung cancer patients. Results:The ROC curve of serum ALP was 0.646, and the diagnostic sensitivity and specificity were 51.2% and 82.6%, respectively. The ROC curve of serum PINP was 0.844, the sensitivity and specificity were 73.2% and 87%, respectively. The ROC curve of PTHrP was 0.791, and the diagnostic sensitivity and specificity were 78% and 67.4% respectively. Among these three markers, PINP was proven to be clinical predictive significance for bone metastasis of lung cancer. The AUC of the combined three markers were 0.903,with a sensitivity of 85.4% and specificity of 89.1%. Besides, the AUC of the combined CEA, CA125 and CYFRA21-1 markers were 0.702, which was not superior to PINP, PTHrP and ALP combination. Conclusion:The detection of ALP, PINP and PTHrP expression level can be used for the differential diagnosis of bone metastasis of lung cancer, and the combined usage was more effective.

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