本文選題：可溶性B7-H4　切入點(diǎn)：癌胚抗原　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的:負(fù)性協(xié)同刺激分子B7-H4是B7家族中的新興成員,它通過抑制T細(xì)胞的增殖、活化,減少細(xì)胞因子的合成、分泌,阻滯細(xì)胞周期的進(jìn)程,從而下調(diào)免疫應(yīng)答,與腫瘤免疫逃逸有關(guān)。B7-H4在多種惡性腫瘤組織和血清中普遍高表達(dá),前期研究已證實(shí),B7-H4在惡性胸腔積液中亦呈現(xiàn)出高水平表達(dá)。本研究初步探討胸腔積液中可溶性B7-H4(sB7-H4)和癌胚抗原(CEA)單獨(dú)或聯(lián)合檢測對(duì)良、惡性胸腔積液的鑒別診斷價(jià)值。方法:收集2015年1月至2015年12月鄭州大學(xué)第一附屬醫(yī)院收治的97例初治胸腔積液患者的胸液標(biāo)本,其中惡性胸腔積液(MPE)55例,良性胸腔積液(BPE)42例。應(yīng)用酶聯(lián)免疫吸附法(ELISA)檢測sB7-H4濃度,應(yīng)用電化學(xué)發(fā)光法檢測CEA水平,采用受試者工作特征曲線(ROC曲線)分析和評(píng)價(jià)sB7-H4和CEA單獨(dú)或聯(lián)合檢測對(duì)良、惡性胸腔積液的鑒別診斷價(jià)值。sB7-H4和CEA之間的關(guān)聯(lián)性采用Pearson積矩相關(guān)分析進(jìn)行。結(jié)果:(1)MPE組和BPE組患者的胸腔積液sB7-H4水平分別為(60.08±35.04)ng/ml versus(27.26±9.55)ng/ml,CEA水平分別為(41.49±37.16)ng/ml versus(2.41±0.94)ng/ml,差異均具有統(tǒng)計(jì)學(xué)意義(P0.01)。(2)胸腔積液sB7-H4診斷MPE的ROC曲線下面積(AUC)為0.884,根據(jù)ROC曲線分析得出sB7-H4診斷MPE的最佳臨床診斷臨界值為37.25ng/ml,靈敏度和特異度分別為81.82%和90.48%;CEA的AUC為0.954,最佳臨床診斷臨界值為4.18 ng/ml,靈敏度和特異度分別為87.28%和95.24%。兩者聯(lián)合檢測時(shí):在并聯(lián)試驗(yàn)(即:當(dāng)sB7-H437.25ng/ml或CEA4.18ng/ml時(shí),則判定為MPE,反之則為BPE)中,靈敏度可提高到90.91%,但特異度降低至88.10%;在串聯(lián)試驗(yàn)(即:當(dāng)sB7-H437.25ng/ml且CEA4.18ng/ml時(shí),則判定為MPE,反之則為BPE)中,靈敏度下降至78.18%,而特異度可提高到97.62%。(3)MPE組胸腔積液sB7-H4水平與CEA含量呈正相關(guān)(P=0.001,r=0.470),BPE組兩者亦呈正相關(guān)(P=0.001,r=0.002)。結(jié)論:胸腔積液sB7-H4可用于良、惡性胸腔積液的鑒別診斷,但未優(yōu)于CEA。sB7-H4和CEA聯(lián)合檢測可提高診斷MPE的靈敏度和特異度。
[Abstract]:Background & AIM: negative co-stimulator B7-H4 is a new member of the B7 family. It down-regulates the immune response by inhibiting T cell proliferation, activation, reducing cytokines synthesis, secretion and blocking the progress of cell cycle. B7-H4 is generally overexpressed in various malignant tumor tissues and serum, which is related to tumor immune escape. Previous studies have confirmed that the expression of B7-H4 in malignant pleural effusion is also high. In this study, we preliminarily studied the detection of soluble B7-H4sB7-H4 and carcinoembryonic antigen (CEA) in pleural effusion. Methods: from January 2015 to December 2015, 97 cases of pleural effusion were collected from the first affiliated Hospital of Zhengzhou University, including 55 cases of malignant pleural effusion. A total of 42 cases of benign pleural effusion were examined for sB7-H4 concentration by enzyme linked immunosorbent assay (Elisa), CEA level by electrochemiluminescence (ECL), and sB7-H4 and CEA were analyzed and evaluated by single or combined detection of sB7-H4 and CEA in 42 cases of benign pleural effusion. The correlation between sB7-H4 and CEA in malignant pleural effusion was analyzed by Pearson moment correlation analysis. Results the level of sB7-H4 in the pleural effusion of the patients in the BPE group and the control group was 60.08 鹵35.04 ng / ml versus(27.26 鹵9.55 ng / ml versus(27.26 respectively, and the level of sB7-H4 was 41.49 鹵37.16 ng / ml versus(2.41 鹵0.94 ng / ml, respectively. The difference was statistically significant. The area under the ROC curve of sB7-H4 in the diagnosis of MPE in pleural effusion was 0.884. According to the analysis of ROC curve, the critical value of sB7-H4 diagnosis for MPE was 37.25 ng / ml, the AUC of sensitivity and specificity were 81.82% and 90.48g / ml, respectively, and the best clinical diagnosis was best. The critical value is 4.18ng / ml, the sensitivity and specificity are 87.28% and 95.24.When the two are combined, they are tested in parallel (i.e. when sB7-H437.25ng/ml or CEA4.18ng/ml, In MPEG, the sensitivity can be increased to 90.91, but the specificity is reduced to 88.10; in the series test (that is, MPEG when sB7-H437.25ng/ml and CEA4.18ng/ml are determined, and BPEwhen vice versa), the sensitivity of MPEG can be increased to 90.91, but the specificity will be reduced to 88.10. The sensitivity decreased to 78.18, and the specificity increased to 97.62.The level of sB7-H4 in pleural effusion was positively correlated with the content of CEA. Conclusion: sB7-H4 in pleural effusion can be used in the differential diagnosis of benign and malignant pleural effusion. But not better than CEA.sB7-H4 and CEA combined detection can improve the sensitivity and specificity of MPE diagnosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R561.3;R730.4
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本文編號(hào)：1561881