血清Cys-C、VEGF、CA153联合检测在乳腺癌早期诊断中的临床价值

目的:通过检测原发性乳腺癌早期患者血清胱抑素C（cystatin C，Cys-C）、血管内皮生长因子（vascular endothelial growth factor，VEGF）与糖类抗原153（carbohydrate antigen 153，CA153）的表达水平，探讨单项和联合检测对乳腺癌早期诊断的临床价值。方法:回顾性分析2018年1月至2020年1月新乡市中心医院收治的153例早期原发性乳腺癌（乳腺癌组）和118例乳腺良性肿瘤（良性肿瘤组）患者；另收集同期该院女性健康体检者86例(对照组)。血清Cys-C、VEGF、CA153依次采用胶乳增强免疫比浊法、酶联免疫吸附法和化学发光免疫法测定。比较三组受检者血清Cys-C、CA153与VEGF水平的差异，分析三指标单项及联合检测对乳腺癌的诊断价值。结果:三组受检者血清Cys-C、CA153与VEGF水平比较，乳腺癌组三项指标明显高于良性肿瘤组和对照组，差异有统计学意义(P<0.05)；乳腺良性肿瘤组血清Cys-C、CA153、VEGF水平与对照组比较无统计学差异(P＞0.05)。血清 Cys-C、CA153、VEGF单项检测临床灵敏度依次为29.41%、26.14%、49.67%，临床特异度依次为89.83%、96.61%、86.44%；三项联合检测灵敏度为73.86%，特异度为75.42%。血清 Cys-C、CA153、VEGF单项诊断乳腺癌的曲线下面积（AUC）依次为0.679、0.801、0.777；Cys-C、CA153、VEGF三项联合检测诊断乳腺癌的AUC为0.875。原发性乳腺癌组血清Cys-C表达水平与肿瘤大小、淋巴结转移、TNM分期、分子分型均无相关性（P＞0.05）。结论:通过血清 Cys-C、CA153、VEGF的联合检测，可以提高原发性乳腺癌的检出率而降低漏检率，在原发性乳腺癌早期诊断中有重要的临床价值。

The clinical value of serum Cys-C,VEGF and CA153 in early diagnosis of breast cancer

Objective:To explore the clinical value of single and combined detection in early diagnosis of breast cancer by detecting the expression of serum cystatin C(Cys-C),vascular endothelial growth factor(VEGF) and carbohydrate antigen 153(CA153) in patients with primary breast cancer.Methods:From January 2018 to January 2020,153 patients with early primary breast cancer(breast cancer group) and 118 patients with benign breast tumors(benign tumor group) admitted to Xinxiang Central Hospital were analyzed retrospectively,and 86 female healthy subjects(control group) who came to our hospital at the same time were collected.Serum VEGF,CA153 and Cys-C were determined by latex enhanced immunoturbidimetry,enzyme-linked immunosorbent assay(ELISA) and chemiluminescence immunoassay respectively.The difference of serum Cys-C,CA153 and VEGF levels among the three groups was compared,and the diagnostic value of three indexes in breast cancer was analyzed.Results:The serum levels of Cys-C,CA153 and VEGF in each group were significantly higher in the breast cancer group than those in the benign tumor group and control group,and the difference was statistically significant(P＜0.05).The serum levels of Cys-C,CA153 and VEGF in the breast benign tumor group were not statistically significant compared with the control group(P>0.05).The single sensitivity of Cys-C,CA153 and VEGF in the breast cancer group was 29.41%,26.14%,49.67%,and the specificity was 89.83%，96.61% and 86.44%,and the three joint detection sensitivity was 73.86% and the specificity was 75.42%.The area under the curve of serum Cys-C,CA153,VEGF in the diagnosis of breast cancer was 0.679,0.801 and 0.777,respectively.The area under the curve of Cys-C,CA153,VEGF combined detection in the diagnosis of breast cancer was 0.875.There was no significant difference in serum Cys-C expression and tumor size,lymph node metastasis,TNM stage and molecular classification in primary breast cancer group(P>0.05).Conclusion:The combined detection of serum Cys-C,CA153,VEGF can improve the detection rate of primary breast cancer and reduce the missed detection rate,so the combined detection of the three indexes has important clinical value in the early diagnosis of primary breast cancer.