目的: 评价上皮细胞黏附分子(epithelial cell adhesion molecule, EpCAM) mRNA和黏蛋白1(mucin 1) mRNA表达水平在良性和恶性胸腔积液鉴别诊断中的临床价值。方法: 应用实时荧光定量PCR检测51例原发于非小细胞肺癌的恶性胸腔积液患者和22例结核性胸膜炎患者胸腔积液标本中的EpCAM mRNA和黏蛋白1 mRNA的表达水平。构建受试者工作特征(ROC)曲线图。计算这两个肿瘤标志物独立或联合测定诊断恶性胸腔积液的敏感性和特异性。结果： 恶性胸腔积液患者胸腔积液标本中EpCAM mRNA和黏蛋白1 mRNA的表达水平均明显高于结核性胸膜炎患者(P=0.000)。根据ROC曲线取EpCAM mRNA和黏蛋白1 mRNA水平的上限值，分别为14.64和11.82；结果显示，EpCAM mRNA 诊断恶性胸腔积液的敏感性和特异性分别为84.3%和90.9%，黏蛋白1 mRNA诊断恶性胸腔积液的敏感性和特异性分别为86.3%和86.4%。采用串行试验联合评价EpCAM mRNA与黏蛋白1 mRNA测定诊断恶性胸腔积液的敏感度和特异性分别为80.4%和95.5%；以平行试验联合评价EpCAM mRNA与黏蛋白1 mRNA测定的敏感性和特异性分别为90.2%和81.8%。结论： EpCAM mRNA与黏蛋白1 mRNA对良性和恶性胸腔积液的鉴别诊断具有较高的临床应用价值，联合检测胸腔积液中EpCAM mRNA与黏蛋白1 mRNA可进一步提高对恶性胸腔积液的诊断效率。
Abstract
Objective: To evaluate the diagnostic value of epithelial cell adhesion molecule (EpCAM) mRNA and mucin 1(MUC1) mRNA expression levels in the pleural fluids for differentiating benign from malignant pleural effusion. Methods: Quantitative real-time PCR was used to detect the expression levels of EpCAM mRNA and MUC1 mRNA in pleural effusion samples from 51 patients with malignant pleural effusion caused by non-small cell lung cancer and 22 patients with tuberculous pleurisy. Receiver operative characteristic (ROC) curves were constructed to assess diagnostic performance. The sensitivity, specificity and accuracy of individual or combined detections of EpCAM mRNA and MUC1 mRNA in the diagnosis of malignant pleural effusion were calculated. Results: The levels of pleural fluid EpCAM mRNA and MUC1 mRNA in patients with malignant pleural effusion were significantly higher than those in patients with tuberculous pleurisy(P=0.000). According to the ROC curve analysis, cut-off values for EpCAM mRNA and MUC1 mRNA in pleural fluid from benign pleural effusion were 14.64 and 11.82, respectively. The sensitivity and specificity of EpCAM mRNA for malignant pleural effusion diagnosis were 84.3% and 90.9%, respectively. The detection of pleural fluid MUC1 mRNA achieved sensitivity of 86.3% and specificity of 86.4%, respectively. When combined EpCAM mRNA and MUC1 mRNA with a serial test, the sensitivity and specificity were 80.4% and 95.5%, respectively. Combination EpCAM mRNA and MUC1 mRNA with a parallel test yielded the 90.2% sensitivity and 81.8% specificity, respectively. Conclusion: Pleural fluid EpCAM mRNA and MUC1 mRNA were two useful tumor markers in the diagnosis of malignant pleural effusion;combination of both two could improve diagnostic performance for distinguishing benign pleural effusion from malignant pleural effusion.
关键词
上皮细胞黏附分子 /
黏蛋白1 /
恶性胸腔积液 /
结核性胸膜炎 /
诊断
{{custom_keyword}} /
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
Shitrit D, Zingerman B, Shitrit AB, et al. Diagnostic value of CYFRA 21-1, CEA, CA19-9, CA15-3, and CA125 assays in pleural effusions: analysis of 116 cases and review
of the literature . Oncologist, 2005, 10(7): 501-507.
［2］Wobbes T, Thomas CM, Segers MF, et al. Evaluation of seven tumor markers (CA50, CA19-9, CA19-9 TruQuant, CA72-4, CA195, carcinoembryonic antigen, and tissue polypeptide
antigen) in the pretreatment sera of patients with gastric carcinoma . Cancer, 1992, 69(8): 2036-2041.
［3］GarciaPachon E, Padilla-Navas I, Dosda MD, et al. Elevated level of carcinoembryonic antigen in nonmalignant pleural effusions . Chest， 1997, 111(3): 643-647.
［4］Riantawan P, Sangsayan P, Bangpattanasiri K, et al. Limited additive value of pleural fluid carcinoembryonic antigen level in malignant pleural effusion . Respiration,
2000, 67(1): 24-29.
［5］Paganuzzi M, Onetto M, Marroni P, et al. Diagnostic value of CYFRA 21-1 tumor marker and CEA in pleural effusion due to mesothelioma. Chest, 2001, 119(4): 1138-1142.
［6］Porcel JM, Vives M, Esquerda A, et al. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15-3, and cytokeratin 19
fragments) in pleural fluid for the differential diagnosis of benign and malignant effusions. Chest， 2004, 126(6): 1757-1763.
［7］Romero S, Fernández C, Arriero JM, et al. CEA, CA 15-3 and CYFRA 21-1 in serum and pleural fluid of patients with pleural effusions . Eur Respir J, 1996, 9(1): 17-
23.
［8］廖君群. 胸腔积液CEA、CA199、CYFRA21-1、AFP 和 FERR在肺癌诊断中的价值. 国际检验医学杂志，2013，34(10): 1216-1218.
［9］Khan MS, Tsigani T, Rashid M, et al. Circulating tumor cells and EpCAM expression in neuroendocrine tumor. Clin Cancer Res , 2011, 17(2):337-345.
［10］Yanamoto S, Kawasaki G, Yoshitomi I, et al. Clinic pathologic significance of EpCAM expression in squamous cell carcinoma of the tongue and its possibility as potential
target for tongue cancer gene therapy. Oral Oncol, 2007, 43(9): 869-877.
［11］Zhang KH, Cao F, Fu QB, et al. Detectionof mRNAs of GA733 genes by RT-PCR in exfoliated cells of pleural and peritoneal effusions and its clinical values. Intern
Med, 2007, 46 (18) :1489-1494．
［12］Guddo F, Giatromanolaki A, Patriarca C, et al. Depolarized expression of episialin (EMA, MUC1) in lung adenocarcinoma is associated with tumor progression .
Anticancer Res, 1998, 18(3B):1915-1920.
［13］Ringel J, Lhr M. The MUC gene family: their role in diagnosis and early detection of pancreatic cancer. Mol Cancer, 2003, 2:9.
［14］蔡祖勋，梁庚正，张学完，等. 肺小细胞肺癌组织中P53和MUC1的表达及其意义. 肿瘤防治杂志，2004，11(7)：694-696.
［15］周龙，李瑶，熊国亮. 胸腔积液中粘蛋白1表达的临床意义. 实用中西医结合临床，2008，8(5):52-53.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
PDF(979 KB)
({{custom_author.role_en}}), {{javascript:window.custom_author_en_index++;}}
