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目的:分析并评价10种外周血细胞游离核酸标志物在胃癌诊断中的应用价值。方法:提取胃癌患者及健康对照者的血清总RNA,反转录后采用实时荧光聚合酶链反应对候选基因进行检测,同时采用电化学发光免疫分析法检测癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CA724,并运用Logistic回归及受试者工作特征(ROC)曲线对标志物进行分析。结果:胃癌患者血清中TP73(DNp73α)及肝细胞生长因子受体c-MET表达量较健康对照者显著增高(P<0.05)。c-MET检测对胃癌诊断的灵敏度为65.5%,特异度为76.4%,曲线下面积(AUC)为0.73,与TP73(DNp73α)比较,两者间的AUC差异有统计学意义(P<0.05)。c-MET与CEA、CA199、CA724联合检测时,其诊断灵敏度为75.0%,特异度为87.3%,AUC为0.83;与仅CEA、CA199、CA724三者联合检测相比,AUC差异有统计学意义(P<0.05)。不同肿瘤转移情况、不同TNM分期的患者,其c-MET表达量明显不同(P<0.05)。结论:检测外周血c-MET表达在胃癌诊断中具有一定价值,可作为临床常用胃癌肿瘤标志物的补充。
Objective: To analyze and evaluate the value of 10 peripheral blood cell free nucleic acid markers in the diagnosis of gastric cancer. Methods: The total RNA was extracted from patients with gastric cancer and healthy controls, and then reverse transcriptase PCR was used to detect the candidate genes. At the same time, CEA and carbohydrate antigens were detected by electrochemiluminescence immunoassay. 19-9 (CA19-9), CA724, and logistic regression and receiver operating characteristic (ROC) curves were used to analyze the markers. Results: Serum levels of TP73 (DNp73α) and hepatocyte growth factor receptor c-MET in gastric cancer patients were significantly higher than those in healthy controls (P <0.05). The sensitivity of c-MET detection for gastric cancer was 65.5%, specificity was 76.4%, and the area under the curve (AUC) was 0.73. There was a significant difference of AUC between the two groups (P <0.05) . The diagnostic sensitivity was 75.0%, the specificity was 87.3%, and the AUC was 0.83 when c-MET was combined with CEA, CA199 and CA724. The AUC was significantly different from the combined detection of CEA, CA199 and CA724 only (P <0.05). The expression of c-MET was significantly different in patients with different tumor metastasis and TNM staging (P <0.05). Conclusion: The detection of c-MET expression in peripheral blood has a certain value in the diagnosis of gastric cancer, which can be used as a complement to the commonly used gastric cancer tumor markers.