血清microRNA-184和microRNA-20a联合检测对胃癌的诊断价值

目的 探讨血清microRNA-184（miR-184）和microRNA-20a（miR-20a）联合检测对胃癌诊断的临床价值。方法 分别选取孝感中心医院332例及368例经病理确诊为慢性胃炎和胃癌的患者。采用荧光定量PCR检测所有患者血清miR-20a与miR-184的表达水平。绘制受试者工作特征（ROC）曲线，评价2种miRNA诊断胃癌的效能。根据ROC曲线确定这2种miRNA诊断胃癌的阈值，计算敏感性和特异性，并对比癌胚抗原（CEA）的测定结果。结果 慢性胃炎组患者血清miR-20a水平较胃癌组患者低（P <0.05）；慢性胃炎组患者血清miR-184水平较胃癌组患者高（P <0.05）。临床病理特征中，胃癌患者血清miR-20a表达水平与临床分期、淋巴结转移、饮酒史、年龄及性别差异无统计学意义（P >0.05）；胃癌患者血清miR-184表达水平与患者淋巴结转移、饮酒史、年龄及性别差异无统计学意义（P >0.05），与肿瘤临床分期有差异（P <0.05）。Logistic回归分析结果显示，血清miR-20a［R=1.012（95% CI：1.697，6.875）］、miR-184［R=2.056（95% CI：0.417，0.722）］表达水平与胃癌的发生相关（P <0.05）。经ROC曲线分析表明，诊断胃癌采用血清miR-20a的临界值为4.24，曲线下面积（AUC）为0.762，特异性为71.7%，敏感性为79.4%；miR-184临界值为10.35，AUC为0.861，特异性为82.8%，敏感性为88.4%；CEA临界值为6 mg/ml，AUC为0.740，特异性为71.4%，敏感性为69.3%；血清miR-20a、miR-184联合诊断胃癌的AUC为0.908，特异性为87.6%，敏感性为84.7%。血清miR-184和miR-20a联合诊断胃癌的AUC、特异性及敏感性较3种单一检测方法大或高。结论 采用血清miR-20a和miR-184联合检测方法诊断胃癌，临床具有一定的应用价值。

Study on diagnostic value of serum miR-184 and miR-20a in gastric cancer

Objective To explore the clinical value of combined detection of miR-184 and miR-20a in serum for the diagnosis of gastric cancer.Methods Totally 332 patients with chronic gastritis and 368 patients with gastric cancer were selected. The expression levels of miR-20a and miR-184 in serum of each group were detected by fluorescence quantitative PCR. ROC analysis was performed by SPSS software to evaluate the efficacy of 2 miRNAs in the diagnosis of gastric cancer. According to the receiver operating characteristic curve(ROC), the threshold value of 2 kinds of serum miRNAs was determined, the specificity and sensitivity of the method were statistically analyzed, and the carcinoembryonic antigen (CEA) were compared.Results The response level of miR-20a in serum of patients with chronic gastritis was significantly lower than that of patients with gastric cancer (P < 0.05), while that of patients with chronic gastritis was significantly higher than that of patients with gastric cancer (P <0.05). There was no significant correlation between the clinical stage, lymph node metastasis, drinking history, age and gender and the level of miR-20a (P > 0.05). There was no significant difference in the expression of miR-184 between patients with gastric cancer and patients with lymph node metastasis, drinking history, age and gender (P > 0.05), except in the clinical stages (P < 0.05). The results of logistic regression analysis showed that the expression levels of miR-20a R = 1.012 (95% CI: 1.697, 6.875)] and miR-184 R = 2.056 (95% CI: 0.417, 0.722)] were correlated with the occurrence of gastric cancer. ROC curve analysis showed that the cutoff, specificity, area under the curve (AUC) and sensitivity of the miR-20a were 4.24, 71.71%, 0.762 and 79.42%, respectively. Those of the miR-184 were 10.35, 82.8%, 0.861 and 88.41%, respectively. Those of the CEA were 6 mg/ml, 71.40%, 0.740 and 69.30%, respectively. The specificity, AUC and sensitivity of the combined serum miR-184 and miR-20a were 87.6%, 0.908, and 84.7%, which were significantly higher than those of 3 single detection methods.Conclusion The detection of miR-20a and miR-184 in serum is of clinical value in the diagnosis of gastric cancer.