本文選題：膽管癌 + CEACAM6��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:研究腫瘤標志物CEACAM6對膽管癌的診斷價值。檢測CEACAM6在膽管癌組織中的蛋白表達水平,并分析其對預后的影響。方法:收集河北醫(yī)科大學第二醫(yī)院2009年3月至2014年4月臨床資料完整的經(jīng)手術切除后病理證實的膽管癌患者組織蠟塊標本70例(腺癌62例,粘液腺癌3例,乳頭狀腺癌3例,鱗癌1例,神經(jīng)內(nèi)分泌癌1例),15例非腫瘤膽道上皮組織作為對照組。收集河北醫(yī)科大學第二醫(yī)院2014年9月至2016年12月臨床資料完整的經(jīng)手術切除后病理證實的膽管癌患者血清標本70例,15例膽管炎患者血清作為對照組。1)首先采用酶聯(lián)免疫吸附測定(ELISA)法測定70例膽管癌患者和15例膽管炎患者血清CEACAM6水平;根據(jù)ROC曲線中敏感性和特異性之和最高點為參考,制定CEACAM6的截斷值并計算ROC曲線下面積;根據(jù)腫瘤標志物診斷效率評估表評價各個腫瘤標志物對膽管癌診斷效率。2)采用免疫組化技術(S-P)法研究檢測CEACAM6在70膽管癌組織和15例非腫瘤膽道上皮組織中的表達情況。并結合患者的年齡、腫瘤大小、有無淋巴結轉移、腫瘤組織分化程度、臨床分期等臨床因素進行綜合分析。采用SPSS21統(tǒng)計軟件進行分析;率的分析用χ2檢驗或Fisher精確檢驗,數(shù)據(jù)采用x±s表示;術后隨訪我們采用門診復查,電話及信訪的方式,隨訪率100%,Kaplan-Meier生存曲線法計算患者生存率并行l(wèi)og-rank檢驗;P0.05具有統(tǒng)計學意義。結果:酶聯(lián)免疫吸附測定(ELISA)結果顯示在膽管癌病人中,CEACAM6的血清值和陽性率與膽管炎組比較有顯著升高(P0.05);根據(jù)制定的ROC曲線,CEACAM6在本次實驗中血清中含量測定的截斷值為0.1851 ng/ml,并分別計算出CEACAM6,CA19-9,CEA的ROC曲線下面積AUC為0.835,0.870,0.828。面積的95%可信區(qū)間為0.758-0.912,0.803-0.936,0.749-0.906。膽管癌敏感性CEACAM6CA19-9CEA(P0.05);特異性CA19-9CEACAM6CEA(P0.05)。免疫組化結果顯示70例膽管癌、15例非腫瘤膽道上皮組織中CEACAM6陽性表達率分別為87.1%、20%,CEACAM6蛋白在膽管癌中的表達明顯高于非腫瘤膽道上皮組織(P0.01)。CEACAM6蛋白表達與膽管癌的臨床分期、淋巴結轉移和組織學分級明顯相關(P0.05)。CEACAM6低表達組生存時間明顯長于高表達組(P0.05)。結論:1 CEACAM6在膽管癌血清中高表達,并且陽性率顯著高于膽管炎對照組,統(tǒng)計學分析顯示有意義。表明CEACAM6的血清學診斷與膽管癌的良惡性存在密切關系,可為膽管癌早期診斷提供思路。2 CEACAM6的ROC曲線分析結果及診斷價值評估表顯示:應用酶聯(lián)免疫吸附測定(ELISA)法,我們得出結論:與CA19-9和CEA比較,CEACAM6具備較高的診斷價值且在敏感性上最高,但特異性較低,總體來說其既具備單獨作為一項腫瘤標志物的診斷價值,也可與CA19-9等相關腫瘤診斷指標行聯(lián)合檢測,可為膽管癌早期診斷提供更好的參考意見。3 CEACAM6蛋白在膽管癌組織中高表達,并且陽性率顯著高于非癌正常膽管組織,統(tǒng)計學分析顯示有意義。因此,CEACAM6在膽管癌組織蛋白表達水平和血清濃度表達水平上的高表達且均具備統(tǒng)計學意義的特點說明CEACAM6可作為膽管癌的早期診斷的腫瘤標志物。4 CEACAM6蛋白在膽管癌組織中的表達情況與患者的年齡、性別,腫瘤大小無相關性,與腫瘤的臨床進展程度,淋巴結轉移、組織分化程度存在相關性�？沙蔀榕袛嗄懝馨⿶盒陨飳W行為的相關指標,說明其表達水平與膽管癌的臨床進程密切相關。5膽管癌組織中CEACAM6的蛋白表達程度與患者預后存在相關性。CEACAM6可能是反映膽管癌發(fā)生發(fā)展及預后的重要生物學指標。
[Abstract]:Objective: To study the diagnostic value of tumor marker CEACAM6 for cholangiocarcinoma. To detect the protein expression level of CEACAM6 in cholangiocarcinoma tissue and to analyze its effect on the prognosis. Methods: to collect the tissue wax blocks of the patients with cholangiocarcinoma confirmed by surgical excision in Second Hospital of Hebei Medical University from March 2009 to April 2014. 70 cases (62 cases of adenocarcinoma, 3 cases of mucinous adenocarcinoma, 3 cases of papillary adenocarcinoma, 1 cases of squamous cell carcinoma, 1 cases of neuroendocrine carcinoma) and 15 cases of non tumor biliary epithelial tissue were used as control group. The serum specimens of the patients with cholangiocarcinoma confirmed by surgical removal from September 2014 to December 2016 of the second hospital of Hebei Medical University were 70 and 15 cases were confirmed. Serum CEACAM6 levels of 70 cholangiocarcinoma and 15 cholangitis were measured by enzyme linked immunosorbent assay (ELISA) in 70 cases of cholangiocarcinoma and 15 cases of cholangitis. The truncation value of CEACAM6 and the area under the ROC curve were calculated according to the sensitivity and specificity of the ROC curve, and the diagnosis of the tumor markers was based on the diagnosis of the tumor markers. The efficiency assessment table was used to evaluate the diagnostic efficiency of tumor markers for cholangiocarcinoma (.2). Immunohistochemical technique (S-P) was used to detect the expression of CEACAM6 in 70 bile duct cancer tissues and 15 non tumor biliary epithelial tissues, and the age, tumor size, lymph node metastasis, tumor tissue differentiation, clinical stage and other clinical stages were combined with the patient's age. The bed factors were analyzed synthetically. The analysis was carried out by SPSS21 statistical software; the analysis of rate was tested by x 2 or Fisher, and the data was expressed by X + s. After the follow-up, we used the outpatient review, the telephone and the letters and visits, the follow-up rate of 100%, the survival rate of the patients by the Kaplan-Meier survival curve and the log-rank test; P0.05 has statistics. Results: the results of enzyme linked immunosorbent assay (ELISA) showed that in the patients with cholangiocarcinoma, the serum and positive rates of CEACAM6 were significantly higher than those in the cholangitis group (P0.05). According to the ROC curve, the truncated value of the serum content of CEACAM6 in this experiment was 0.1851 ng/ml, and the ROC curves of CEACAM6, CA19-9 and CEA were calculated respectively. The 95% confidence interval of the area of AUC under the line of 0.835,0.870,0.828. was 0.758-0.912,0.803-0.936,0.749-0.906. cholangiocarcinoma sensitivity CEACAM6CA19-9CEA (P0.05) and specific CA19-9CEACAM6CEA (P0.05). The immunohistochemical results showed that 70 cases of cholangiocarcinoma and 15 cases of non tumor biliary epithelial tissue were 87.1%, 20%, and CEACAM6 eggs, respectively. The expression of white in cholangiocarcinoma was significantly higher than that of non tumor biliary epithelial tissue (P0.01).CEACAM6 protein expression and clinical stage of cholangiocarcinoma. Lymph node metastasis and histological grade were significantly correlated (P0.05).CEACAM6 low expression group was significantly longer than high expression group (P0.05). Conclusion: 1 CEACAM6 in cholangiocarcinoma serum high expression, and positive rate Statistically significant higher than the control group of cholangitis, statistical analysis showed that the serological diagnosis of CEACAM6 was closely related to the benign and malignant cholangiocarcinoma. The results of the ROC curve analysis for the early diagnosis of cholangiocarcinoma and the assessment of the value of the diagnostic value of.2 CEACAM6 showed that the application of enzyme linked immunosorbent assay (ELISA) method, we concluded the conclusion. Compared with CA19-9 and CEA, CEACAM6 has high diagnostic value and is of the highest sensitivity, but its specificity is low. In general, it not only has the diagnostic value of a tumor marker alone, but also can be combined with CA19-9 and other related tumor diagnosis indicators. It can provide a better reference for the early diagnosis of cholangiocarcinoma.3 CEACAM6 eggs. White is highly expressed in cholangiocarcinoma, and the positive rate is significantly higher than that of non cancer normal bile duct tissue. Statistical analysis shows significance. Therefore, the high expression of CEACAM6 in the expression level of cholangiocarcinoma tissue protein and the level of serum concentration is statistically significant and CEACAM6 can be used as an early diagnosis of cholangiocarcinoma. The expression of the tumor marker.4 CEACAM6 protein in the cholangiocarcinoma tissue is not related to the age, sex, and the size of the tumor. It is related to the clinical progress, lymph node metastasis and the degree of tissue differentiation. It can be a relative index to judge the malignant biological behavior of cholangiocarcinoma, indicating the expression level of the cholangiocarcinoma and the clinical of the cholangiocarcinoma. The protein expression of CEACAM6 in.5 cholangiocarcinoma tissue is closely related to the prognosis of patients with.CEACAM6, which may be an important biological indicator to reflect the development and prognosis of cholangiocarcinoma.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.8

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