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目的探讨巨噬细胞抑制因子-1(MIC-1)作为血清肿瘤标志物对胰腺癌的临床诊断价值。方法采用酶联免疫法(ELISA)检测35例胰腺癌和30例胰腺良性疾病及30例健康对照者的血清MIC-1水平,并与CA19-9作比较。结果胰腺癌患者的血清MIC-1水平[(1 589.8±838.5)pg/mL]显著高于胰腺良性疾病者[(400.6±104.3)pg/mL]及健康对照者[(386.1±145.5)pg/mL](均P<0.01),而胰腺良性疾病者与健康对照者之间差异无统计学意义(P>0.05)。MIC-1检测诊断胰腺癌的敏感性、特异性、阳性预测值、阴性预测值和受试者操作特征曲线下面积(AUC)分别为85.7%,93.3%,93.8%,84.9%和0.973,分别高于CA19-9的对应值74.3%,90.0%,89.6%,75.0%和0.862。两者联合检测对胰腺癌诊断的敏感性为91.4%,特异性为83.3%。在胰腺良性疾病患者中,MIC-1阳性率显著低于CA19-9阳性率(3.3%vs.26.7%,P<0.05);伴有黄疸者的CA19-9阳性率显著高于无黄疸者(55.6%vs.14.3%,P<0.05),而有无黄疸对MIC-1阳性率无明显影响(P>0.05)。结论血清MIC-1对胰腺癌的综合诊断能力优于CA19-9,有望成为胰腺癌新的血清肿瘤标志物。
Objective To investigate the clinical value of macrophage inhibitory factor-1 (MIC-1) as a serum tumor marker in the diagnosis of pancreatic cancer. Methods Serum MIC-1 levels were measured by enzyme-linked immunosorbent assay (ELISA) in 35 patients with pancreatic cancer, 30 benign pancreatic diseases and 30 healthy controls, and compared with CA19-9. Results Serum MIC-1 levels in patients with pancreatic cancer [(1 589.8 ± 838.5) pg / mL] were significantly higher than those in patients with benign pancreatic disease [(400.6 ± 104.3) pg / mL] and healthy controls [(386.1 ± 145.5) mL] (all P <0.01), while there was no significant difference between benign pancreatic diseases and healthy controls (P> 0.05). The sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operating characteristic curve of the MIC-1 test were 85.7%, 93.3%, 93.8%, 84.9% and 0.973, respectively The corresponding values higher than CA19-9 were 74.3%, 90.0%, 89.6%, 75.0% and 0.862. The combined detection of the two has a sensitivity of 91.4% and a specificity of 83.3% for the diagnosis of pancreatic cancer. The positive rate of MIC-1 in patients with benign pancreatic diseases was significantly lower than that of CA19-9 (3.3% vs.26.7%, P <0.05). The positive rate of CA19-9 in patients with jaundice was significantly higher than those without jaundice 55.6% vs.14.3%, P <0.05), while the presence or absence of jaundice had no significant effect on the positive rate of MIC-1 (P> 0.05). Conclusion The serum MIC-1 is superior to CA19-9 in the comprehensive diagnosis of pancreatic cancer, which is expected to become a new serum tumor marker of pancreatic cancer.