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近年来,乳腺癌在我国的发病率呈逐年升高趋势,目前已居女性恶性肿瘤的首位[1-3]。虽然已经提出并运用多种治疗策略来根除乳腺癌,但其病死率仍居高不下[4]。究其原因主要与乳腺癌早期诊断延误和复发转移密切相关,因此乳腺癌早期诊断和治疗后病情及时有效评估一直是乳腺癌基础研究与临床研究的热点与难点。胱抑素C (Cysatin C, Cys C)是调节半胱氨酸蛋白酶胞外活性的主要内源性抑制剂,具有抑制半胱氨酸蛋白酶调解细胞外蛋白水解的生理功能。研究[5]显示,Cys C还参与了结肠癌、胃癌、子宫内膜癌及黑色素瘤等恶性肿瘤的进展过程。但Cys C能否作为一种新的标志物用于乳腺癌诊断与病情评估,目前相关报道则不多见。我们采用胶乳增强透射免疫比浊法和Western blotting法分别检测了乳腺癌病人血清及组织Cys C的表达水平,分析乳腺癌病人血清与组织Cys C表达状况,探讨血清Cys C在乳腺癌筛查、诊断及病情评估监测等方面的临床价值。现作报道。
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血清Cys C含量乳腺癌组高于对照组和良性病组,良性病组高于对照组(P < 0.01)(见表 1)。其中部分病人(53例乳腺癌病人中42例)同时检测了术后血清Cys C含量,结果显示手术治疗后乳腺癌病人血清Cys C水平(1.063±0.045)mg/L较术前未治疗时血清Cys C水平(1.182±0.037)mg/L降低(t=2.77,P < 0.01)。
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通过对乳腺癌病人血清Cys C检测结果作ROC曲线分析,结果显示Cys C曲线下面积(AUC)为0.84,ROC曲线上约登指数最大处对应的临界值(1.015 mg/L)作为截断值,Cys C≤1.015 mg/L为阴性,Cys C>1.015 mg/L为阳性,其诊断乳腺癌的敏感度为67.92%,特异性为80.00%,准确度73.12%,有较高的诊断效能(见图 1)。
分组 n Cys C/(mg/L) 乳腺癌组 53 1.168±0.040 良性病组 48 1.003±0.043** 对照组 40 0.868±0.025**△△ F — 742.44 P — < 0.01 MS组内 — 0.001 q检验:与乳腺癌组比较**P < 0.01;与良性病组比较△△P < 0.01 表 1 3组血清Cys C水平比较(x±s)
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46例乳腺癌病人(53例乳腺癌病人中有完整临床病理资料的46例),其中年龄>50岁、肿瘤直径≥2 cm、浸润型导管癌、有淋巴结转移、临床分型为Ⅲ型的乳腺癌病人血清Cys C含量高于年龄≤50岁、肿瘤大小 < 2 cm、浸润型小叶癌、无淋巴结转移、临床分型为Ⅰ~Ⅱ型的病人,差异均有统计学意义(P < 0.01) (见表 2)。
临床参数 n Cys C/(mg/L) t P 年龄/岁 > 50 22 1.204±0.048 5.49 < 0.01 ≤50 24 1.107±0.069 肿瘤直径/cm ≥2 21 1.209±0.073 5.70 < 0.01 < 2 25 1.106±0.049 病理类型 浸润型导管癌 38 1.164±0.049 3.08 < 0.01 浸润型小叶癌 8 1.099 ±0.076 淋巴结转移 有 13 1.322±0.102 8.11* < 0.01 无 33 1.086±0.039 临床分级 Ⅰ~Ⅱ 40 1.111±0.040 4.95* < 0.01 Ⅲ 6 1.433±0.159 *示t′值 表 2 乳腺癌病人不同临床病理特征与其血清Cys C表达差异(x±s)
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53例乳腺癌病人癌组织及癌旁组织蛋白提取符合Western blotting法检测要求的40例,48例乳腺良性肿瘤病人组织蛋白提取符合要求的35例。Western blotting法检测结果显示,Cys C蛋白在乳腺癌组织表达低于癌旁组织,癌旁组织表达低于乳腺良性肿瘤组织,差异均有统计学意义(P < 0.01)(见图 2、表 3)。
分组 n Cys C 乳腺癌旁组织 40 0.800±0.029 乳腺良性肿瘤组织 35 0.697±0.054** 乳腺癌组织 40 0.457±0.056**△△ F — 543.43 P — < 0.01 MS组内 — 0.002 q检验:与乳腺癌旁组织比较**P < 0.01;与乳腺良性肿瘤组织比较△△P < 0.01 表 3 乳腺癌组织、癌旁组织及良性肿瘤组织Cys C蛋白相对表达水平比较(x±s)
血清胱抑素C检测在乳腺癌筛查、诊断及术后评估中的临床价值
Clinical value of serum cystatin C level in the screening, diagnosis and postoperative evaluation of patients with breast cancer
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摘要:
目的探讨胱抑素C(Cys C)在乳腺癌病人血清和癌组织中的表达水平,以及在乳腺癌筛查、诊断及病情评估中的临床应用价值。 方法选取原发性乳腺癌病人53例作为乳腺癌组,同期住院治疗的乳腺良性肿瘤病人48例为良性病组,另选同期体检的健康女性40名为对照组,应用胶乳增强透射免疫比浊法检测各组血清Cys C水平,用受试者工作特征曲线评估血清Cys C检测对乳腺癌的诊断效能(灵敏度,特异性与准确度);Western blotting法检测乳腺良性肿瘤、乳腺癌组织与癌旁正常组织(对照组织)Cys C蛋白表达状况。 结果血清Cys C含量乳腺癌组高于对照组和良性病组,良性病组高于对照组(P < 0.01),手术治疗后乳腺癌病人血清Cys C水平较术前未治疗时降低(P < 0.01)。Cys C≤1.015 mg/L为阴性,Cys C>1.015 mg/L为阳性,其诊断乳腺癌的敏感度为67.92%,特异性为80.00%,准确度73.12%。年龄>50岁、肿瘤大小≥2 cm、浸润型导管癌、有淋巴结转移、临床分型为Ⅲ型的乳腺癌病人血清Cys C含量分别高于年龄≤50岁、肿瘤大小 < 2 cm、浸润型小叶癌、无淋巴结转移、临床分型为Ⅰ~Ⅱ型的病人,差异均有统计学意义(P < 0.01)。Cys C蛋白在乳腺癌组织表达低于癌旁组织,癌旁组织表达高于乳腺良性肿瘤组织(P < 0.01)。 结论血清Cys C检测在临床乳腺癌筛查与诊断中具有较好的灵敏度、特异性和准确度;癌组织与血清Cys C表达水平的异质性可能与其在乳腺癌进展中的作用密切相关。 Abstract:ObjectiveTo investigate the expression levels of cystatin C(Cys C) in serum and cancerous tissue of patients with breast cancer, and its clinical value in the screening, diagnosis and disease evaluation of patients with breast cancer. MethodsFifty-three patients with primary breast cancer, 48 patients with benign breast tumor and 40 healthy females were divided into the breast cancer group, benign group and control group, respectively.For the three groups, the serum Cys C levels were detected using latex enhances transmission immunity turbidimetry, and the diagnostic efficacy(including sensitivity, specificity, and accuracy rating) of serum Cys C in breast cancer were evaluated using ROC curve.The expression levels of Cys C protein in breast benign tumor tissues, breast cancerous tissues and para-cancerous tissues were detected using Western blotting. ResultsThe serum level of Cys C in breast cancer group was significantly higher than that in control group and benign group(P < 0.01), and the level of Cys C in benign group was higher than that in control group(P < 0.01).The serum level of Cys C in breast cancer patients after operation was lower than that before operation(P < 0.01).When the Cys C≤1.015 mg/L was negative, and Cys C>1.015 mg/L was positive, the sensitivity, specificity and accuracy of Cys C in diagnosing breast cancer were 67.92%, 80.00% and 73.12%, respectively.The serum levels of Cys C in breast cancer patients with age >50 years old, tumor size ≥2 cm, infiltrating ductal carcinoma, lymph node metastasis and clinical classification for Ⅲ type were higher than those in breast cancer patients with age ≤50 years old, tumor size < 2 cm, infiltrating lobular carcinoma, no lymph node metastasis and clinical classification for Ⅰ-Ⅱ type, respectively, and the differences of which were statistically significant(P < 0.01).The results of Western blotting showed that the expression level of Cys C protein in breast cancer tissues was lower than that in para-cancerous tissues, and the expression level of Cys C protein in para-cancerous tissues was higher than that in benign breast tissues(P < 0.01). ConclusionsDetecting the serum level of Cys C has good sensitivity, specificity and accuracy in clinical screening and diagnosis of breast cancer.The heterogeneity of Cys C expression in cancer tissues and serum may be closely related to its role in breast cancer progression. -
Key words:
- breast neoplasm /
- Cysatin C /
- biochemical marker
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表 1 3组血清Cys C水平比较(x±s)
分组 n Cys C/(mg/L) 乳腺癌组 53 1.168±0.040 良性病组 48 1.003±0.043** 对照组 40 0.868±0.025**△△ F — 742.44 P — < 0.01 MS组内 — 0.001 q检验:与乳腺癌组比较**P < 0.01;与良性病组比较△△P < 0.01 表 2 乳腺癌病人不同临床病理特征与其血清Cys C表达差异(x±s)
临床参数 n Cys C/(mg/L) t P 年龄/岁 > 50 22 1.204±0.048 5.49 < 0.01 ≤50 24 1.107±0.069 肿瘤直径/cm ≥2 21 1.209±0.073 5.70 < 0.01 < 2 25 1.106±0.049 病理类型 浸润型导管癌 38 1.164±0.049 3.08 < 0.01 浸润型小叶癌 8 1.099 ±0.076 淋巴结转移 有 13 1.322±0.102 8.11* < 0.01 无 33 1.086±0.039 临床分级 Ⅰ~Ⅱ 40 1.111±0.040 4.95* < 0.01 Ⅲ 6 1.433±0.159 *示t′值 表 3 乳腺癌组织、癌旁组织及良性肿瘤组织Cys C蛋白相对表达水平比较(x±s)
分组 n Cys C 乳腺癌旁组织 40 0.800±0.029 乳腺良性肿瘤组织 35 0.697±0.054** 乳腺癌组织 40 0.457±0.056**△△ F — 543.43 P — < 0.01 MS组内 — 0.002 q检验:与乳腺癌旁组织比较**P < 0.01;与乳腺良性肿瘤组织比较△△P < 0.01 -
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