胆管癌中胆汁和血清粘蛋白5AC的评估：诊断效能及生物学意义

Assessment of bile and serum mucin5AC in cholangiocarcinoma: diagnostic performance and biologic significance.

作者信息

Danese Elisa, Ruzzenente Orazio, Ruzzenente Andrea, Iacono Calogero, Bertuzzo Francesca, Gelati Matteo, Conci Simone, Bendinelli Sharon, Bonizzato Giada, Guglielmi Alfredo, Salvagno Gian Luca, Lippi Giuseppe, Guidi Gian Cesare

机构信息

Section of Clinical Biochemistry, Department of Life and Reproduction Sciences, University Hospital of Verona, Verona, Italy.

出版信息

Surgery. 2014 Nov;156(5):1218-24. doi: 10.1016/j.surg.2014.05.006. Epub 2014 Aug 21.

DOI:10.1016/j.surg.2014.05.006

PMID:25151557

Abstract

BACKGROUND

Recent studies have showed the efficacy of mucin5AC (MUC5AC) as a diagnostic and prognostic serum biomarker in biliary tract tumors. The aim of the present investigation was to improve the current knowledge on the biologic relevance of MUC5AC in malignant and benign biliary disorders by comparing its diagnostic performance in both bile and serum samples of patients with cholangiocarcinoma (CCA) or benign biliary disorders.

METHODS

A quantitative determination of MUC5AC by enzyme-linked immunosorbent assay was performed in bile and serum specimens from 26 patients with extrahepatic CCA and 20 subjects with benign biliary disorders (10 with biliary stones and 10 with cholangitis). Verification analysis was made by immunoblot.

RESULTS

MUC5AC of serum and biliary origin contributed to different extent to total levels of MUC5AC in the different groups of patients. In particular, the transition toward a greater degree of injury of bile duct epithelium was accompanied by a greater amount of MUC5AC in serum than in bile. The diagnostic performance of MUC5AC expressed as serum/bile ratio showed excellent diagnostic performance for differentiating CCA from cholangitis (area under the curve [AUC], 0.94; 95% CI, 0.86-1.00; P < .0001), CCA from biliary stones (AUC, 0.99; 95% CI, 0.98-1.00; P < .0001), as well as cholangitis from biliary stones (AUC, 0.93; 95% CI, 0.82-1.00; P = .001).

CONCLUSION

These findings provide new insight into the biologic importance of MUC5AC in biliary disorders and suggest that combined assessment of MUC5AC in bile and serum with expression of data in terms of serum to bile ratio may improve the diagnostic performance of MUC5AC quantification in serum alone.

摘要

背景

近期研究显示粘蛋白5AC（MUC5AC）作为胆道肿瘤诊断和预后血清生物标志物的有效性。本研究的目的是通过比较MUC5AC在胆管癌（CCA）或良性胆道疾病患者胆汁和血清样本中的诊断性能，提高对MUC5AC在恶性和良性胆道疾病中生物学相关性的现有认识。

方法

采用酶联免疫吸附测定法对26例肝外CCA患者和20例良性胆道疾病患者（10例胆结石患者和10例胆管炎患者）的胆汁和血清标本进行MUC5AC定量测定。通过免疫印迹进行验证分析。

结果

血清和胆汁来源的MUC5AC对不同患者组中MUC5AC总水平的贡献程度不同。特别是，随着胆管上皮损伤程度加重，血清中MUC5AC的含量高于胆汁。以血清/胆汁比值表示的MUC5AC诊断性能在区分CCA与胆管炎（曲线下面积[AUC]，0.94；95%可信区间，0.86 - 1.00；P <.0001）、CCA与胆结石（AUC，0.99；95%可信区间，0.98 - 1.00；P <.0001）以及胆管炎与胆结石（AUC，0.93；95%可信区间，0.82 - 1.00；P =.001）方面表现出优异的诊断性能。