细胞角蛋白19片段、蛋白激酶B和糖类抗原19-9水平联合超声内镜检查术对胃肠道间质瘤的鉴别价值

Diagnostic value of gastrointestinal stromal tumors by CYFRA21-1, PKB, CA19-9 combined with endoscopic ultrasonography

摘要:

目的 分析细胞角蛋白19片段（CYFRA21-1）、蛋白激酶B（PKB）和糖类抗原19-9（CA19-9）水平联合超声内镜检查术（EUS）对胃肠道间质瘤和非胃肠道间质瘤的鉴别价值。方法 前瞻性纳入2020年1月－2023年7月该院收治的69例胃肠道间质瘤患者作为研究组，另择同期78例非胃肠道间质瘤患者（胃肠道平滑肌瘤25例，胃肠道神经鞘瘤53例）作为对照组。比较两组患者一般资料、EUS指标和肿瘤标志物，绘制受试者操作特征曲线（ROC curve），分析血清CYFRA21-1、PKB和CA19-9水平单独检测，以及联合EUS，对胃肠道间质瘤的诊断价值。结果 与对照组比较，研究组灰度平均值、灰度标准偏差、血清CYFRA21-1、PKB和CA19-9水平更高（P < 0.05）。不同性别和年龄的胃肠道间质瘤患者，灰度平均值、灰度标准偏差、血清CYFRA21-1、PKB和CA19-9水平比较，差异均无统计学意义（P > 0.05）。与肿瘤直径 ≤ 5 cm、病理性核分裂象 ≤ 5个/50 HPF的胃肠道间质瘤患者比较，肿瘤直径 > 5 cm、病理性核分裂象 > 5个/50 HPF的胃肠道间质瘤患者，灰度平均值、灰度标准偏差、血清CYFRA21-1、PKB和CA19-9水平更高（P < 0.05）。将胃肠道间质瘤纳入阳性，非胃肠道间质瘤纳入阴性，ROC curve显示，联合检测胃肠道间质瘤的诊断价值高于EUS、血清CYFRA21-1、PKB和CA19-9水平单独检测，曲线下面积（AUC）为0.936，敏感度为82.61%，特异度为91.03%。结论 在胃肠道间质瘤中，CYFRA21-1、PKB、CA19-9水平、灰度平均值和灰度标准偏差升高，CYFRA21-1、PKB和CA19-9水平联合EUS在胃肠道间质瘤中诊断价值较高。

Abstract:

Objective To analyze the differential value of gastrointestinal stromal tumors and non-gastrointestinal stromal tumor by cytokeratin-19 fragment (CYFRA21-1), protein kinase B (PKB) and carbohydrate antigen 19-9 (CA19-9) combined with endoscopic ultrasonography (EUS).Methods 69 patients with gastrointestinal stromal tumors from January 2020 to July 2023 were selected as the study group, and 78 patients with non-gastrointestinal stromal tumor (they were 25 cases of gastrointestinal leiomyoma and 53 cases of gastrointestinal schwannoma) were selected as the control group during the same period prospectively. The EUS indicators and tumor markers in the two groups were compared. Receiver operator characteristic curve (ROC curve) was drawn to analyze the diagnostic value of serum levels of CYFRA21-1, PKB and CA19-9 alone and in combination for gastrointestinal stromal tumors.Results Compared with the control group, the mean gray level, gray standard deviation and serum levels of CYFRA21-1, PKB and CA19-9 in the study group were higher (P < 0.05). There was no significant difference in mean gray level, gray standard deviation and serum levels of CYFRA21-1, PKB and CA19-9 in patients with gastrointestinal stromal tumors of different genders and ages (P > 0.05). Compared with patients with gastrointestinal stromal tumors with tumor diameter ≤ 5 cm and pathological mitotic figure ≤ 5 /50 HPF, the mean gray level, gray standard deviation and serum levels of CYFRA21-1, PKB and CA19-9 were higher in patients with gastrointestinal stromal tumors with tumor diameter > 5 cm and pathological mitotic figure > 5 /50 HPF (P < 0.05). Gastrointestinal stromal tumors were included as positive and non-gastrointestinal stromal tumor as negative. ROC curve was drawn to analyze the diagnostic value of gray mean value, gray standard deviation, serum levels of CYFRA21-1, PKB, and CA19-9 alone and in combination for gastrointestinal stromal tumors, and the combined detection was the highest, area under the curve (AUC) was 0.936, the sensitivity was 82.61%, and the specificity was 91.03%.Conclusion With the occurrence and development of gastrointestinal stromal tumors, CYFRA21-1, PKB, CA19-9 levels, gray mean value and gray standard deviation increase, and levels of CYFRA21-1, PKB, CA19-9 combined with EUS are valuable in the diagnosis of gastrointestinal stromal tumors.