【摘要】 目的探讨血清人乳腺珠蛋白(hMAM)水平与乳腺癌早期诊断和癌微转移的相关性及其临床意义。方法采用酶联免疫吸附试验(ELISA)分别检测64例乳腺癌患者、32例其他癌患者(直肠癌、胃癌、卵巢癌、前列腺癌患者各8例)、34例良性乳腺相关疾病肿瘤患者和36例体检正常的女性(正常对照组)的血清人乳腺珠蛋白水平并做比较。将64例乳腺癌患者分别按临床TNM分期、雌激素受体(ER)表达程度、腋窝淋巴结的转移程度及绝经与否分组并做比较。通过受试者的工作特征曲线(即ROC曲线)确定乳腺癌患者的hMAM的Cut-off值。结果血清hMAM的ROC曲线面积为0.855,即乳腺癌诊断结果的可信度为85.5%;血清hMAM的Cut-off值为8.54 ng/ml,其特异性和敏感度分别为83.2%和75.9%。在血清hMAM水平和阳性率的比较中,乳腺癌组明显高于其他三组(P<0.05),且其他三组间差异无显著性(P>0.05)。Ⅲ和Ⅳ期乳腺癌患者的血清hMAM阳性率(62.50%、75.00%)明显高于Ⅰ和Ⅱ期患者(31.25%、37.50%,P<0.05),但hMAM水平无显著性差异(P>0.05)。存在腋窝淋巴结转移的乳腺癌患者的血清hMAM的阳性率(90.91%)明显高于无转移的患者(25.00%)(P<0.05),但hMAM水平无显著性差异(P>0.05)。乳腺癌患者的血清中是否存在ER以及是否绝经对hMAM及阳性率均无显著性差异(P>0.05)。结论乳腺癌临床TNM分期及腋窝淋巴结转移程度与hMAM的表达存在相关性;在乳腺癌高危人群的血清检验中,hMAM的检测有助于提高乳腺癌早期诊断的临床意义,在诊断乳腺癌早期微转移与治疗中具有关键性作用。更多还原

【Abstract】 Objective To explore the correlation of serum level of human mammaglobin(h MAM) with early diagnosis and micro-metastasis of breast cancer and to study the clinical significance of h MAM. Methods The serum levels of h MAM in 64 patients with breast cancer,32 patients with other cancers(8 patients with prostate cancer,8 patients with gastric cancer,8 patients with ovarian cancer and 8 patients with colorectal cancer),34 patients with benign breast disease and 36 healthy females(control group) were determined by enzyme linked immunosorbent assay(ELISA) and their results were analyzed. These 64 patients with breast cancer were classified by TNM staging,they were grouping according to the existence of expression of estrogen receptor(ER),metastasis in axillary lymph nodes and menopause. The cut-off value of serum level of h MAM in patients with breast cancer was determined by receiver operating characteristic(ROC) curve. Results The area under ROC curve of serum level of h MAM was 0. 855,and the reliability of diagnosis in breast cancer was 85. 5% [95% confidence interval(CI) : 72. 6% ~ 92.4%]. When the cut-off value of h MAM was 8. 54 ng/ml,the respective specificity and sensitivity were 83. 2% and 75. 9% respectively. Serum level of h MAM and positive rate in breast cancer group was significantly higher than that of benign breast disease group,other cancer group and control group(P < 0. 05). The difference among benign breast disease group,other cancer group and control group was not statistically significant(P > 0. 05). The positive rates of serum level of h MAM in patients with III and IV stages breast cancer(62. 50% and 75. 00%) were significantly higher than those of patients in I and II stages(31. 25% and 37. 50%,P < 0. 05),but there was no difference in levels of h MAM(P >0. 05). The positive rate of serum h MAM in patients with breast cancer associated with metastasis in axillary lymph nodes(90. 91%) was significantly higher than those without metastasis(25. 00%,P < 0. 05),but the difference in serum level of h MAM was not significant(P > 0. 05).Regardless of whether existed ER expression and menopause,serum level of h MAM and positive rate in patients with breast cancer had no difference(P > 0. 05). with those without metastasis(25. 00%,P < 0. 05),but the difference in serum level of h MAM was not significant(P > 0.05). Conclusion There are correlation between clinical TNM staging of patients with breast cancer and the degree of metastatsis in axillary lymph nodes. In screening of breast tumor in high risk female patients,the examination of serum level of h MAM is helpful in early detection of patients with breast cancer. It is also important in early detection of micro-metastasis and early treatment.更多还原