Diagnostic and prognostic value of serum alpha 2HS-glycoprotein antibody in breast cancer
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摘要:目的
探讨血清人胎球蛋白A (AHSG)抗体在早期乳腺癌诊断及预后评估中的临床价值。
方法收集101例早期乳腺癌患者(乳腺癌组)、50例乳腺良性疾病患者(良性疾病组)、50例体检健康女性(对照组)血清标本。采用酶联免疫吸附试验检测3组研究对象血清AHSG抗体、糖类抗原153(CA153)和癌胚抗原(CEA)水平; 比较Ⅰ期、Ⅱ期乳腺癌患者血清AHSG抗体、CEA、CA153水平; 采用受试者工作特征(ROC)曲线评估AHSG抗体、CEA、CA153单项检测及联合检测对早期乳腺癌的诊断效能。
结果乳腺癌组血清AHSG抗体水平高于良性疾病组和对照组, 差异有统计学意义(P < 0.05);Ⅱ期乳腺癌患者血清AHSG抗体、CEA、CA153水平高于Ⅰ期乳腺癌患者，差异有统计学意义(P < 0.05)。AHSG抗体单项检测的曲线下面积(AUC)、灵敏度、特异度、阳性预测值、阴性预测值、准确度均高于CA153和CEA; 3项联合检测的各诊断指标均高于单项检测。乳腺癌患者手术后血清AHSG抗体、CEA、CA153水平低于术前，差异有统计学意义(P < 0.05)。
结论血清AHSG抗体有望成为早期乳腺癌诊断和预后监测的生物标志物。
Abstract:ObjectiveTo investigate the clinical value of serum alpha 2HS-glycoprotein (AHSG) antibody in the diagnosis of early breast cancer and prognosis of these patients.
MethodsSerum samples were collected from 101 patients with early breast cancer (breast cancer group), 50 patients with benign breast disease (benign disease group) and 50 healthy women (control group). Serum AHSG antibody, carbohydrate antigen 153 (CA153) and carcinoembryonic antigen (CEA) levels of study objects were detected by enzyme-linked immunosorbent assay; the serum levels of AHSG antibody, CEA and CA153 in patients with stage Ⅰ and Ⅱ breast cancer were compared. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of AHSG antibody, CEA and CA153 alone and their combination for early breast cancer.
ResultsThe serum AHSG antibody level in the breast cancer group was significantly higher than that in the benign disease group and control group (P < 0.05). Serum levels of AHSG antibody, CEA and CA153 in stage Ⅱ breast cancer patients were significantly higher than those in the stage Ⅰ (P < 0.05). The area under curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value and accuracy of AHSG antibody were higher than those of CA153 and CEA; the diagnostic indexes of three combined tests were higher than those of single test. The levels of serum AHSG antibody, CEA and CA153 in patients with breast cancer after operation were significantly lower than those before operation (P < 0.05).
ConclusionSerum AHSG antibody is expected to be a biomarker for early diagnosis and prognostic monitoring of breast cancer.
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表 1 3组血清AHSG抗体、CEA、CA153水平比较[M(P25, P75)]
组别 n CEA/(ng/mL) CA153/(U/mL) AHSG抗体/(ng/mL) 对照组 50 1.82(1.23, 2.50) 10.91(8.03, 14.89) 29.30(22.65, 36.10) 良性疾病组 50 1.77(1.33, 3.28) 13.60(10.00, 23.87)* 33.45(23.04, 42.34) 乳腺癌组 101 3.21(1.82, 10.92)*# 26.86(13.78, 50.73)*# 58.27(46.02, 72.28)*# AHSG: 胎球蛋白A; CA153: 糖类抗原153; CEA: 癌胚抗原。与对照组比较, * P < 0.05; 与良性疾病组比较, #P < 0.05。 
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表 2 不同分期乳腺癌患者血清AHSG抗体、CEA、CA153水平比较[M(P25, P75)]
肿瘤分期 n CEA/(ng/mL) CA153/(U/mL) AHSG抗体/(ng/mL) Ⅰ期 45 2.35(1.23, 3.90) 16.30(9.26, 28.30) 48.18(39.58, 56.05) Ⅱ期 56 8.84(2.60, 15.32)* 46.34(21.26, 61.83)* 70.04(58.56, 81.53)* AHSG: 胎球蛋白A; CA153: 糖类抗原153; CEA: 癌胚抗原。与Ⅰ期比较, * P < 0.05。
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表 3 血清AHSG抗体、CEA、CA153的诊断效能
指标 灵敏度/% 特异度/% 准确度/% 阳性预测值/% 阴性预测值/% AUC(95%CI) CEA 70.3 65.0 68.2 67.6 68.8 0.717(0.645~0.788) CA153 74.3 69.0 71.6 70.8 72.6 0.756(0.689~0.823) AHSG抗体 80.2 85.0 83.6 85.4 81.9 0.896(0.854~0.938) 3项联合 84.2 90.0 87.6 90.4 85.1 0.934(0.903~0.965) AHSG: 胎球蛋白A; CA153: 糖类抗原153; CEA: 癌胚抗原。
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表 4 乳腺癌患者手术前后血清AHSG抗体、CEA、CA153水平比较[M(P25, P75)]
时点 n CEA/(ng/mL) CA153/(U/mL) AHSG抗体/(ng/mL) 术前 32 11.31(8.61, 17.38) 57.37(50.17, 69.80) 72.99(62.93, 84.42) 术后 32 2.30(1.34, 5.21)* 9.97(6.63, 15.30)* 23.42(8.47, 35.11)* AHSG: 胎球蛋白A; CA153: 糖类抗原153; CEA: 癌胚抗原。与术前比较, *P < 0.05。
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