细胞外热休克蛋白90α在胸腔积液鉴别诊断中的临床价值

Clinical value of extracellular heat shock protein 90 α in differential diagnosis of pleural effusion

摘要:

目的 探讨细胞外热休克蛋白90α(eHsp90α)在良恶性胸腔积液(PE)鉴别诊断中的临床价值。方法 选取2017年4月至2018年6月陕西省肿瘤医院和陕西省人民医院收治的合并PE住院患者80例为研究对象，将50例恶性肿瘤患者作为研究组，30例良性疾病患者作为对照组。两组患者均采用酶联免疫吸附法(ELISA)检测PE中热休克蛋白(Hsp90α)、乳酸脱氢酶(LDH)水平；采用受试者工作特征曲线(ROC)评估Hsp90α、LDH单独及联合检测对良恶性PE的诊断效能。结果 研究组Hsp90α水平187.90(68.68,334.97)μg/L高于对照组3.90(1.24,44.47)μg/L,差异有统计学意义(P<0.05);研究组LDH水平302.00(159.00,450.00)U/L高于对照组126.00(103.50,251.00)U/L,差异有统计学意义(P<0.05);ROC曲线分析显示，Hsp90α对恶性PE(MPE)的最佳截断值为16.88μg/L,曲线下面积(AUC)为0.900(95%CI:0.793～0.963),灵敏度为100.00%,特异度为73.33%。Hsp90α单独检测与联合LDH检测的诊断效能相当(P>0.05)。结论 MPE中Hsp90α水平高于良性PE(BPE),其单独及联合LDH检测对良恶性PE均具有较高的鉴别诊断效能，可作为MPE的辅助诊断指标。

Abstract:

Objective Toevaluatetheclinicalvalueofextracellularheatshockprotein90α(eHsp90α)indistinguishing betweenbenignand malignantpleuraleffusion (PE).Methods Atotalof80inpatientscomplicatedbyPEinShaanxi ProvincialCancerHospitalandShaanxiProvincialPeople'sHospitalfrom April2017toJune2018 wereenrolled.Among them,50patientswithmalignancieswereassignedtothestudygroup,while30patientswithbenigndiseasesservedasthe controlgroup.Enzyme-linkedimmunosorbentassay (ELISA)wasemployedtomeasureheatshockprotein90α(Hsp90α) andlactatedehydrogenase(LDH)levelsinPEfrombothgroups.Receiveroperatingcharacteristic(ROC)curveanalysiswas conductedtoassessthediagnosticefficacyofHsp90α,LDH,andtheircombinationindifferentiatingmalignantfrombenign PE(BPE).Results ThelevelofHsp90αinthestudygroupwassignificantlyhigherthanthatinthecontrolgroup[187.90 (68.68,334.97)μg/Lvs.3.90 (1.24,44.47)μg/L;P <0.05].ThelevelofLDHinthestudygroup waselevated comparedtothatinthecontrolgroup[302.00(159.00,450.00)U/Lvs.126.00(103.50,251.00)U/L;P<0.05].ROC analysisrevealedanoptimaldiagnosticcutoffvalueof16.88μg/LforHsp90αinindentifying MPE,withanareaunderthe curve(AUC)of0.900 (95% CI:0.793-0.963),asensitivityof100%,andaspecificityof73.33%.Nosignificant differenceindiagnosticefficacywasobservedbetweenHsp90αaloneanditscombinationwithLDH (P>0.05).Conclusion The levelofHsp90αinMPEissignificantlyelevatedcomparedtothatinBPE.ThedetectionofHsp90αaloneorincombination withLDHdemonstratesrobustdiagnosticperformancefordifferentiating MPEfrom BPE.Thus,Hsp90αmayserveasan auxiliarybiomarkerforidentifyingmalignantPE.