摘要目的 探讨高迁移率族蛋白B1(HMGB1)在食管鳞癌患者血清中的表达及其作为食管鳞癌肿瘤标志物的可行性.方法 回顾性分析201 1年1-12月间天津医科大学附属肿瘤医院食管肿瘤科收治的78例食管鳞癌患者的临床病理资料,以酶联免疫吸附测定法、电发光免疫测定法和微粒酶联免疫测定法分别检测78例食管鳞癌患者术前和术后1个月血清HMGB1、癌胚抗原(CEA)、细胞角蛋白19片段抗原(Cyfra21-1)及鳞状上皮细胞癌相关抗原(SCC)的水平.以60名健康成人血清HMGB1的95％单侧参考值范围作为阳性判定标准(大于96 μg/L)；以CEA大于5.0 μg/L、Cyfra21-1大于3.3 μg/L、SCC大于1.5μg/L作为其他血清标记物的阳性判定标准.结果 78例食管鳞癌患者术前血清HMGB1水平为(748.7±92.4) μg/L,其表达水平与肿瘤大小、浸润深度、淋巴结转移及肿瘤分期有关(P＜0.01,P＜0.05).术后1个月,患者血清HMGB1表达水平为(181.4±20.5) μg/L,较术前明显下降(P＜0.01)；但在T4、N1和Ⅲ期中仍相对较高(P＜0.01,P＜0.05).血清HMGB1对食管鳞癌诊断的灵敏度为84.6％(66/78),明显高于CEA[10.3％ (8/78)]、Cyfra21-1[25.6％(20/78)]和SCC [42.3％ (33/78)]；但4种血清肿瘤标记物特异度均较高,分别为93.3％(56/60)、88.3％(53/60)、90.0％(54/60)和93.3％(56/60).结论 与CEA、Cyfra21-1和SCC相比,血清HMGB1检测食管鳞癌灵敏度高,易于检测,特异度好,可作为肿瘤标志物用于食管鳞癌的辅助诊断、病期评价及预后判断.

abstractsObjective To explore the level of serum high-mobility group box 1 (HMGB1) in patients with esophageal squamous cell carcinoma (ESCC) and the feasibility of HMGB1 as a tumor marker.Methods Serum HMGB1,carcinoembryonic antigen (CEA),cytokeratin 19 fragment antigen (Cyfra21-1) and squamous cell carcinoma antigen (SCC) were measured by enzyme-linked immunosorbent assay (ELISA),electrochemiluminescence immunoassay (ECLIA)and microparticle enzyme immunoassay (MEIA) respectively in 78 patients with ESCC preoperatively as well as a month after esophagectomy.At the same time,serum HMGB1,CEA,Cyfra21-1 and SCC of 60 healthy adult volunteers were detected with the same method.The unilateral P95 value of serum HMGB1 (＞ 96 μg/L) was defined as positive.According to the Roche kit diagnostic criteria,CEA＞5.0 μg/L,Cyfra21-1＞3.3 μg/L and SCC＞1.5 μg/L were defined as positive.Results The preoperative positive ratio of serum HMGB1 in 78 patients with ESCC was 84.6％,and the level of serum HMGB1 was associated with the tumor size,infiltration depth,lymph node metastasis and tumor stage (P＜0.01 or P＜0.05).One month after esophagectomy,the level of serum HMGB1 in ESCC declined significantly compared with the preoperative level(P＜0.01),and the level of serum HMGB1 in T4,N1,stage Ⅲ was higher compared to corresponding T,N and tumor stage (P＜0.01 or P＜0.05).The positive ratio of CEA,Cyfra21-1 and SCC was 10.3％,25.6％ and 42.3％ respectively in 78 ESCC patients preoperatively,so the sensitivity of these tumor markers was lower.One month after esophagectomy,serum Cyfra21-1 and serum SCC were significantly decreased compared to the preoperative level (P＜0.01).However,there was no significant difference of preoperative serum CEA compared to a month after esophagectomy in ESCC(P＞ 0.05).The specificity of HMGB1,CEA,Cyfra21-1 and SCC were 93.3％,88.3％,90.0％ and 93.3％ respectively.Conclusion Compared to CEA,Cyfra21-1 and SCC,serum HMGB1 in ESCC patients is easier for detection and its sensitivity and specificity are higher,which may be used as a marker in diagnosis,prediction of prognosis and monitor of postoperative recurrence of ESCC.