CAJ | 학술논문

目的观察原发性肝癌(PHC)患者血清微小RNA (miRNA)-29b的表达,探讨miRNA-29b和甲胎蛋白(AFP)联合检测对PHC的诊断意义.方法收集2007年1月-2010年5月温州医学院附属第一医院外科96名健康志愿者、87例住院PHC患者术前和术后血清,采用定量反转录PCR检测miRNA-29b表达量及ELISA法检测AFP含量,并分析miRNA-29b表达水平与各临床参数间的关系.结果 PHC组miRNA-29b[0.250(0.124～0.381)]与健康对照组[0.860 (0.587～1.338)]及PHC术后7d组[0.890(0.637～1.414)]比较,表达量明显低(P ＜0.001).PHC组AFP含量[65.4(20.1 ～212.3)μg/L]与健康对照组[13.3(7.1～19.8) μg/L],及PHC术后7d组[23.2(11.6～55.7) μg/L]比较,表达量明显高(P ＜0.001).miRNA-29b表达水平与病程发展相关,分化程度越低及TNM分期越高其表达水平就越低(P＜0.045和P＜0.001).Kaplan-Meier结果显示miRNA-29b低表达组的生存率远低于其高表达组,其中位生存期(月)分别为25.52和36.94(P =0.008).Cox多变量分析显示miRNA-29b水平是影响PHC患者生存率的独立危险因素之一,相对危险度为0.482(95％ CI:0.236～0.985).当ROC曲线确诊PHC的miRNA-29b临界值为0.38和AFP临界值为23.1 μg/L时,PHC组血清miRNA-29b、AFP单项检测的敏感度分别为75.9％和70.1％,特异度分别为89.5％和92.7％,两者联合检测的敏感度为87.3％,特异度为88.5％.结论血清miRNA-29b的测定有助于PHC的诊断和预后的估计,联合AFP检测则可有效提高PHC诊断率.
목적 관찰원발성간암(PHC)환자혈청미소RNA (miRNA)-29b적표체,탐토miRNA-29b화갑태단백(AFP)연합검측대PHC적진단의의.방법 수집2007년1월-2010년5월온주의학원부속제일의원외과96명건강지원자、87례주원PHC환자술전화술후혈청,채용정량반전록PCR검측miRNA-29b표체량급ELISA법검측AFP함량,병분석miRNA-29b표체수평여각림상삼수간적관계.결과 PHC조miRNA-29b[0.250(0.124～0.381)]여건강대조조[0.860 (0.587～1.338)]급PHC술후7d조[0.890(0.637～1.414)]비교,표체량명현저(P ＜0.001).PHC조AFP함량[65.4(20.1 ～212.3)μg/L]여건강대조조[13.3(7.1～19.8) μg/L],급PHC술후7d조[23.2(11.6～55.7) μg/L]비교,표체량명현고(P ＜0.001).miRNA-29b표체수평여병정발전상관,분화정도월저급TNM분기월고기표체수평취월저(P＜0.045화P＜0.001).Kaplan-Meier결과현시miRNA-29b저표체조적생존솔원저우기고표체조,기중위생존기(월)분별위25.52화36.94(P =0.008).Cox다변량분석현시miRNA-29b수평시영향PHC환자생존솔적독립위험인소지일,상대위험도위0.482(95％ CI:0.236～0.985).당ROC곡선학진PHC적miRNA-29b림계치위0.38화AFP림계치위23.1 μg/L시,PHC조혈청miRNA-29b、AFP단항검측적민감도분별위75.9％화70.1％,특이도분별위89.5％화92.7％,량자연합검측적민감도위87.3％,특이도위88.5％.결론 혈청miRNA-29b적측정유조우PHC적진단화예후적고계,연합AFP검측칙가유효제고PHC진단솔.
Objective To explore the clinical value of miRNA-29b expression and the combined detection of serum miRNA-29b and alpha-fetoprotein (AFP) in the diagnosis of primary hepatic carcinoma (PHC).Methods From January 2007 to May 2010,the serum levels of miRNA-29b and AFP from 96 healthy controls and 87 PHC patients were measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) respectively.The relationship of miRNA-29b and various clinical parameters was analyzed.Results Serum levels of miRNA-29b in PHC pre-operative group (0.250 (0.124-0.381)) significantly decreased versus the control group [0.860 (0.587-1.338)] and the post-operative group (0.890 (0.637-1.414)) (P ＜ 0.001).Also,the levels of AFP in PHC pre-operative group (65.4 (20.1-212.3)) was obviously higher than that in the control group (13.3(7.1-19.8)) and the post-operative group (23.2(11.6-55.7)) (P ＜0.001).A lower expression of miRNA-29b was correlated with lower differentiation and higher TNM stages (P ＜ 0.045,P ＜ 0.001).Kaplan-Meier curve analysis revealed that PHC patients with a low serum expression of miRNA-29b had a significantly shortened overall survival when compared with a high serum expression of miRNA-29b(25.52 vs 36.94 months,P =0.008).Multivariable Cox regression analysis indicated that the serum expression of miRNA-29b was an independent risk factor for overall survival.Relative risk was 0.482 (95％ confidence interval:0.236-0.985).The critical values for miRNA-29b and AFP were determined at 0.38 and 23.1 μg/L through the ROC curves.Under the critical value,the sensitivity of miRNA-29b and AFP were 75.9％ and 70.1％ and the specificity of miRNA-29b and AFP 89.5％ and 92.7％ respectively.Combined detection could increase the sensitivity up to 87.3％,and achieve a specificity of 88.5％.Conclusion The combined detection of miRNA-29b and AFP aids the diagnosis of PHC and the prediction of its prognosis.