胃双重超声造影结合血清巨噬细胞炎症蛋白1与血管细胞黏附分子1检测对胃癌术前分期的价值
| 作者: |
1张超贤,
2郭李柯,
1秦咏梅,
1李光艳
1 新乡医学院第一附属医院消化内科，河南 卫辉 453100 2 新乡医学院第一附属医院口腔科，河南 卫辉 453100 |
| 通讯: |
张超贤
Email: g75zh@aliyun.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2016.04.018 |
摘要
目的：探讨胃双重超声造影（DCEUS）联合血清巨噬细胞炎症蛋白1（MIP-1）与血管细胞黏附分子1（VCAM-1）检测对胃癌术前分期的临床价值。方法：685例胃癌患者术前行胃镜和DCEUS检查并进行术前分期，同时运用ELISA法检测术前血清MIP-1与VCAM-1水平，根据术后病理分期，比较DCEUS与DCEUS联合MIP-1与VCAM-1检测对胃癌术前分期判断准确性。结果：DCEUS对胃癌T分期判断的敏感性（特异性）分别为T1 93.10%（92.05%）、T2 67.47%（65.50%）、T3 78.62%（80.47%）、T4 91.41%（90.70%），总准确率为80.15%；对N分期判断的敏感性（特异性）分别为N0 90.55%（80.99%）、N1 63.57%（73.87%）、N2 88.40%（92.50%）、N3 82.35%（73.68%），总准确率为82.92%；对M分期判断的敏感性（特异性）分别为：M0 99.29%（84.82%）、M1 71.48%（98.43%），总准确率为88.61%。血清MIP-1和VCAM-1水平与胃癌组织浸润程度、淋巴结转移、远处转移和病理分期均有关（均P<0.05）。DCEUS联合MIP-1、VCAM-1检测对T分期判断的敏感性（特异性）分别为T1 93.10%（92.05%）、T2 87.95%（94.19%）、T3 95.07%（92.33%）、T4 91.41%（90.70%），总准确率为92.41%；对N分期判断的敏感性（特异性）分别为：N0 98.43%（96.90%）、N1 89.15%（94.26%）、N2 95.22%（95.22%）、N3 92.65%（89.36%），总准确率为94.16%；对M分期判断的敏感性（特异性）分别为M0 99.76%（97.68%）、M1 96.20%（99.61%），总准确率为98.39%。DCEUS联合MIP-1、VCAM-1检测对判断胃癌T、N、M分期的准确率均明显高于DCEUS（均P<0.05）。结论：胃癌的病理分期与血清MIP-1和VCAM-1表达密切相关，DCEUS联合术前检测MIP-1和VCAM-1血清水平，有利于提高胃癌术前分期判断的准确性。
关键词：
胃肿瘤
肿瘤分期
超声检查
巨噬细胞炎性蛋白质类
血管细胞黏附分子1
Value of double contrast-enhanced ultrasonography combined with measurement of serum macrophage inflammatory protein 1 and vascular cell adhesion molecule 1 in preoperative staging for gastric carcinoma
CorrespondingAuthor:ZHANG Chaoxian Email: g75zh@aliyun.com
Abstract
Objective: To assess the clinical value of double contrast-enhanced ultrasonography (DCEUS) of the stomach combined with determination of serum macrophage inflammatory protein 1 (MIP-1) and vascular cell adhesion molecule 1 (VCAM-1) in preoperative staging for gastric cancer. Methods: Six-hundred and eighty-five patients with gastric cancer underwent gastroscopy and DCEUS examination for preoperative staging, and meanwhile, their preoperative MIP-1 and VCAM-1 levels were measured by ELISA assay. According to the results of postoperative pathological tumor staging, the accuracy in preoperative stage estimation of gastric carcinoma between DCEUS and DCEUS plus MIP-1 and VCAM-1 measurement was compared. Results: The sensitivity (specificity) of DCEUS in estimating T stage of gastric cancer was 93.10% (92.05%) for T1, 67.47% (65.50%) for T2, 78.62% (80.47%) for T3 and 91.41% (90.70%) T4 respectively, with an overall accuracy rate of 80.15%, in estimating N stage was 90.55% (80.99%) for N0, 63.57 % (73.87%) for N1, 88.40% (92.50%) for N2 and 82.35% (73.68%) for N3 respectively, with an overall accuracy rate of 82.92%, and in estimating M stage was 99.29% (84.82%) for M0 and 71.48% (98.43%) for M1 respectively, with an overall accuracy rate of 88.61%. Both serum levels of MIP-1 and VCAM-1 were significantly related to the degree of invasion, lymphatic metastasis, distant metastasis and pathological stage of gastric carcinoma (all P<0.05). The sensitivity (specificity) of DCEUS plus MIP-1 and VCAM-1 measurement in estimating T stage of gastric cancer was 93.10% (92.05%) for T1, 87.95% (94.19%) for T2, 95.07% (92.33%) for T3 and 91.41% (90.70%) for T4 respectively, with an overall accuracy rate of 92.41%, in estimating N stage was 98.43% (96.90%) for N0, 89.15% (94.26%) for N1, 95.22 % (95.22%) for N2 and 92.65% (89.36%) for N3 respectively, with an overall accuracy rate of 94.16%, and in estimating M stage was 99.76% (97.68%) for M0 and 96.20%(99.61%) for M1 respectively, with an overall accuracy rate of 98.39%. The overall accuracy rates of DCEUS plus MIP-1 and VCAM-1 measurement in estimating either T, N or M stage of gastric cancer was significantly higher than that of DCEUS alone (all P<0.05). Conclusion: Serum levels of MIP-1 and VCAM-1 are closely related to pathological stage of gastric cancer, and DCEUS in combination with MIP-1 and VCAM-1 detection may help increase the accuracy rate of preoperative staging of gastric cancer.
Keywords：