超声内镜检查术联合血清丝氨酸蛋白酶抑制剂Kazal 1型和分泌型磷蛋白1对食管癌的早期诊断价值

Early diagnostic value of endoscopic ultrasonography combined with serum SPINK1 and SPP1 in esophageal cancer

摘要:

目的 探讨超声内镜检查术（EUS）联合血清丝氨酸蛋白酶抑制剂Kazal 1型（SPINK1）和分泌型磷蛋白1（SPP1）早期诊断食管癌的临床价值。方法 选取2021年6月－2023年5月于该院就诊的276例患者作为研究对象。经手术病理诊断为食管癌92例，作为食管癌组，同期收治且经组织活检判定为食管良性病变89例，作为良性病变组，同期在该院体检且身体健康的95例正常人，作为健康对照组。以病理结果为金标准，验证EUS诊断食管癌的准确率；比较3组患者血清SPINK1和SPP1表达情况；探讨食管癌患者血清SPINK1和SPP1表达与病理特征的关系；采用受试者操作特征曲线（ROC curve）分析EUS联合血清SPINK1和SPP1水平检测对食管癌的早期诊断效能。结果 EUS结果显示，81例被诊断为食管癌，79例被诊断为良性病变，11例漏诊，10例误诊，准确率为88.40%（160/181）；与健康对照组和良性病变组比较，食管癌组血清SPINK1和SPP1表达水平明显升高，良性病变组血清SPINK1和SPP1表达水平明显高于健康对照组，差异均有统计学意义（P < 0.05）；血清SPINK1表达与患者肿瘤直径 > 2 cm、淋巴结转移、淋巴结阳性和组织分级为Ⅲ级有关（P < 0.05），血清SPP1表达水平与肿瘤直径 > 2 cm、淋巴结转移、淋巴结阳性和雌激素受体阳性有关（P < 0.05）；ROC curve显示，EUS、血清SPINK1、SPP1水平单独检测和三者联合检测，早期诊断食管癌的曲线下面积（AUC）分别为0.862，0.834，0.782和0.926，三者联合早期诊断食管癌的临床效能明显优于EUS、血清SPINK1和SPP1单独检测（Z = 2.30、Z = 3.70、Z = 4.23，P = 0.022、P = 0.000、P = 0.000）。结论 食管癌患者血清SPINK1和SPP1表达均异常上调，EUS联合血清SPINK1和SPP1表达水平联合检测用于早期诊断食管癌，具有较高的临床应用价值。

Abstract:

Objective To explore the clinical value of endoscopic ultrasonography (EUS) combined with serum serine protease inhibitor Kazal 1 (SPINK1) and secretory phosphoprotein 1 (SPP1) in early diagnosis of esophageal cancer.Methods 276 patients from June 2021 to May 2023 were selected as the study objects. 92 cases of esophageal cancer diagnosed by operation and pathology were esophageal cancer group, another 89 patients diagnosed as benign esophageal lesions through tissue biopsy were selected as the benign lesion group, and 95 healthy individuals who underwent physical examinations were collected as the healthy control group, general information such as age and gender of subjects in three groups were collected and organized; using pathological results as the gold standard, the accuracy of EUS in diagnosing esophageal cancer was verified; the expression of serum SPINK1 and SPP1 was compared among the esophageal cancer group, benign lesion group, and healthy control group; the relationship between the expression of serum SPINK1 and SPP1 in esophageal cancer patients and their clinical and pathological characteristics was explored; efficacy of EUS combined with serum SPINK1, SPP1 levels for early diagnosis of esophageal cancer was analyzed using receiver operator characteristic curve (ROC curve).Results Compared with the gold standard, the results of EUS examination showed that 81 cases were diagnosed with esophageal cancer, 79 cases were diagnosed with benign lesions, 11 cases were missed diagnosed, and 10 cases were misdiagnosed, with an accuracy rate of 88.40% (160/181); Compared with the healthy control group and the benign lesion group, the expression levels of serum SPINK1 and SPP1 in the esophageal cancer group were obviously increased, the expression levels of serum SPINK1 and SPP1 in the benign lesion group were significantly higher than those in the healthy control group, the differences were statistically significant (P < 0.05); Serum SPINK1 expression was linked to tumor diameter > 2 cm, presence of lymph node metastasis, lymph node positivity, and tissue grading level 3 in patients (P < 0.05). Serum SPP1 expression level was related to tumor diameter > 2 cm, presence of lymph node metastasis, lymph node positivity, and estrogen receptor positivity of patients (P < 0.05); ROC curve showed that the area under the curve (AUC) of EUS, serum SPINK1, SPP1 levels, and their combination in the early diagnosis of esophageal cancer was 0.862, 0.834, 0.782, and 0.926, respectively, the clinical efficacy of the combination of the three in the early diagnosis of esophageal cancer was superior to that of EUS, serum SPINK1, and SPP1 alone (Z = 2.30, Z = 3.70, Z = 4.23, P = 0.022, P = 0.000, P = 0.000).Conclusion The expression levels of serum SPINK1 and SPP1 in esophageal cancer patients are abnormally up-regulated. The combination of EUS and serum SPINK1 and SPP1 has high clinical value in early diagnosis of esophageal cancer.