血清MAGEA3、HE4在肺癌患者辅助诊断中的应用价值

摘要/Abstract

摘要：

目的探究血清黑色素瘤相关抗原A3（MAGEA3）、人附睾蛋白4（HE4）在肺癌患者辅助诊断中的应用价值。方法选择2021年1月至2024年1月康复大学青岛中心医院收治的134例肺癌患者作为研究对象（研究组），选取同期158例体检健康人群作为对照组。采用酶联免疫吸附试验测定血清MAGEA3、HE4水平。以研究组治疗前MAGEA3、HE4水平均数为中界值，将肺癌患者分别分为MAGEA3高水平组（≥58.69 pg/ml，n=66）和低水平组（<58.69 pg/ml，n=68）、HE4高水平组（≥125.04 pmol/L，n=69）和低水平组（<125.04 pmol/L，n=65）。采用受试者操作特征（ROC）曲线评估治疗前血清MAGEA3、HE4水平对肺癌的诊断效能。结果研究组治疗前血清MAGEA3、HE4水平分别为（58.69±16.14）pg/ml、（125.04±28.49）pmol/L，对照组分别为（43.52±14.83）pg/ml、（96.85±22.33）pmol/L，研究组MAGEA3、HE4水平均显著高于对照组，差异均有统计学意义（t=8.36，P<0.001；t=9.47，P<0.001）。研究组治疗后血清MAGEA3、HE4水平分别为（46.73±15.42）pg/ml、（113.26±24.73）pmol/L，治疗后血清MAGEA3、HE4水平均显著低于治疗前，差异均有统计学意义（t=16.07，P<0.001；t=9.27，P<0.001）。治疗前血清MAGEA3高水平组与低水平组肺癌患者的分化程度（χ²=6.20，P=0.013）、TNM分期（χ²=7.27，P=0.007）、淋巴结转移（χ²=7.07，P=0.008）差异均有统计学意义。治疗前血清HE4高水平组与低水平组肺癌患者的分化程度（χ²=4.93，P=0.026）、TNM分期（χ²=7.31，P=0.007）、淋巴结转移（χ²=9.85，P=0.002）差异均有统计学意义。ROC曲线分析显示，治疗前血清MAGEA3、HE4单独诊断肺癌的曲线下面积（AUC）分别为0.77（95%CI为0.72~0.83）、0.76（95%CI为0.70~0.81），二者联合诊断肺癌的AUC为0.87（95%CI为0.83~0.91），二者联合诊断肺癌的价值优于MAGEA3（Z=2.92，P=0.003）、HE4（Z=3.24，P=0.001）单独诊断。结论与健康人群相比，肺癌患者治疗前血清MAGEA3、HE4水平显著升高，且治疗后血清MAGEA3、HE4水平均显著低于治疗前，二者联合诊断肺癌的效能更优，可作为肺癌患者辅助诊断的工具。

关键词:肺肿瘤,诊断,黑色素瘤相关抗原A3,人附睾蛋白4

Abstract:

ObjectiveTo explore the application value of serum melanoma-associated antigen A3 （MAGEA3） and human epididymis protein 4 （HE4） in the auxiliary diagnosis of lung cancer patients.MethodsA total of 134 patients with lung cancer who underwent treatment at Qingdao Central Hospital， University of Health and Rehabilitation Sciences from January 2021 to January 2024 were selected as study subjects （study group）， and 158 healthy people who underwent physical examination during the same period were selected as control group. Enzyme linked immunosorbent assay was applied to measure the serum level of MAGEA3 and HE4. According to the median MAGEA3 and HE4 levels before treatment of the study group， lung cancer patients were divided into MAGEA3 high level group （≥58.69 pg/ml，n=66）， low level group （<58.69 pg/ml，n=68） and HE4 high level group （≥125.04 pmol/L，n=69） and low level group （<125.04 pmol/L，n=65）. Receiver operator characteristic （ROC） curves were plotted to evaluate the diagnostic performance of serum MAGEA3 and HE4 level for lung cancer before treatment.ResultsSerum MAGEA3 and HE4 levels before treatment in the study group were （58.69±16.14） pg/ml and （125.04±28.49） pmol/L， and those in the control group were （43.52±14.83） pg/ml and （96.85±22.33） pmol/L， respectively. The levels of MAGEA3 and HE4 in the study group were significantly higher than those in the control group， with statistically significant differences （t=8.36，P<0.001；t=9.47，P<0.001）. Serum MAGEA3 and HE4 levels after treatment in the study group were （46.73±15.42） pg/ml and （113.26±24.73） pmol/L， respectively， serum MAGEA3 and HE4 levels after treatment were significantly lower than those before treatment， with statistically significant differences （t=16.07，P<0.001；t=9.27，P<0.001）. There were significant differences in differentiation degree （χ²=6.20，P=0.013）， TNM staging （χ²=7.27，P=0.007） and lymph node metastasis （χ²=7.07，P=0.008） of lung cancer patients between the MAGEA3 high level group and the low level group before treatment. There were significant differences in differentiation degree （χ²=4.93，P=0.026）， TNM staging （χ²=7.31，P=0.007） and lymph node metastasis （χ²=9.85，P=0.002） of lung cancer patients between the HE4 high level group and the low level group before treatment. The ROC curve analysis showed that， the area under the curve （AUC） of serum MAGEA3 and HE4 alone for diagnosing lung cancer before treatment were 0.77 （95%CI： 0.72-0.83） and 0.76 （95%CI： 0.70-0.81）， and the AUC of the above two combined for diagnosing lung cancer was 0.87 （95%CI： 0.83-0.91）， and the combined diagnosis value of the two was higher than that of MAGEA3 （Z=2.92，P=0.003） and HE4 （Z=3.24，P=0.001） alone.ConclusionCompared with healthy people， serum MAGEA3 and HE4 levels before treatment of lung cancer patients are significantly increased， and serum MAGEA3 and HE4 levels are significantly lower after treatment than those before treatment. The combination of the two is more effective in diagnosis for lung cancer and can be used as an auxiliary diagnostic tool for lung cancer patients.

Key words:Lung neoplasms,Diagnosis,Melanoma-associated antigen A3,Human epididymis protein 4

孙浩淼, 孙海波, 孙建岭. 血清MAGEA3、HE4在肺癌患者辅助诊断中的应用价值[J]. 国际肿瘤学杂志, 2024, 51(12): 749-754.

Sun Haomiao, Sun Haibo, Sun Jianling. Application value of serum MAGEA3 and HE4 in the auxiliary diagnosis of lung cancer patients[J]. Journal of International Oncology, 2024, 51(12): 749-754.

图/表5

一般临床资料	对照组（n=158）	研究组（n=134）	t/χ²值	P值
年龄（岁）	61.82±5.03	62.65±5.14	1.39	0.165
BMI（kg/m²）	22.94±2.08	23.36±2.15	1.69	0.092
性别
男	84	81	1.57	0.211
女	74	53

表1

组别	MAGEA3（pg/ml）	HE4（pmol/L）
对照组（n=158）	43.52±14.83	96.85±22.33
研究组（n=134）
治疗前	58.69±16.14	125.04±28.49
治疗后	46.73±15.42	113.26±24.73
t₁值	8.36	9.47
P₁值	<0.001	<0.001
t₂值	16.07	9.27
P₂值	<0.001	<0.001

表2

表3

治疗前血清MAGEA3、HE4水平与肺癌患者临床资料的关系（$\bar{x} \pm s$/例）"

临床资料	MAGEA3				HE4
临床资料	高水平组（n=66）	低水平组（n=68）	t/χ²值	P值	高水平组（n=69）	低水平组（n=65）	t/χ²值	P值
年龄（岁）	63.47±5.22	61.85±5.03	1.83	0.070	63.06±5.18	62.21±5.11	0.96	0.341
BMI（kg/m²）	23.68±2.52	23.04±2.31	1.53	0.128	23.56±2.47	23.14±2.28	1.02	0.309
性别
男	45	36	3.25	0.071	46	35	2.30	0.129
女	21	32	3.25	0.071	23	30	2.30	0.129
分化程度
低分化	46	33	6.20	0.013	47	32	4.93	0.026
中/高分化	20	35	6.20	0.013	22	33	4.93	0.026
TNM分期
Ⅰ~Ⅱ期	37	53	7.27	0.007	39	51	7.31	0.007
Ⅲ~Ⅳ期	29	15	7.27	0.007	30	14	7.31	0.007
淋巴结转移
无	42	57	7.07	0.008	43	56	9.85	0.002
有	24	11	7.07	0.008	26	9	9.85	0.002

表3

指标	AUC	95%CI	敏感性（%）	特异性（%）
MAGEA3	0.77	0.72~0.83	77.60	70.90
HE4	0.76	0.70~0.81	61.90	85.40
二者联合	0.87	0.83~0.91	80.60	87.30

表4

图1

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