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目的检测食管癌患者血浆循环DNA的含量并探讨其与临床病理特征之间的关系。方法采集44例食管癌患者及100例健康对照的外周血,用磁珠法提取DNA、双重实时荧光定量PCR检测血浆DNA含量,并用放免法检测血清CEA水平。结果食管癌患者血浆DNA含量(中位数:54.0 ng/m l,四分位数区间:38.0~68.1 ng/m l)显著高于健康对照(中位数:18.5ng/m l,四分位区间:15.5~24.9 ng/m l),P<0.001。Ⅱa期、Ⅱb期和Ⅲ~Ⅳ期患者血浆DNA含量分别37.0(27.2~46.2)ng/m l、53.0(41.4~63.7)ng/m l和66.3(55.9~81.8)ng/m l。Ⅲ~Ⅳ期明显高于Ⅱa~Ⅱb期(P=0.003)。Ⅱa和Ⅱb期组的血浆DNA含量显著高于健康对照组(P<0.001)。高、中分化组和低分化组的血浆DNA含量分别为32.3(24.2~55.1)ng/m l、52.9(42.5~69.6)ng/m l和65.0(57.7~88.6)ng/m l,低分化组显著高于高、中分化组(P=0.010)。以32.3 ng/mL作为临界值,血浆DNA诊断敏感性为91.2%,特异性为90.0%,ROC曲线下面积为0.959(95%C I 0.915~1.000),优于血清CEA。结论检测血浆DNA对食管癌的筛查、早期诊断、判断肿瘤侵袭与转移具有重要价值。
Objective To detect the content of circulating DNA in patients with esophageal cancer and to explore its relationship with clinicopathological features. Methods Peripheral blood of 44 patients with esophageal cancer and 100 healthy controls were collected. DNA was extracted by magnetic beads method. DNA content was detected by double real - time PCR. Serum CEA level was detected by radioimmunoassay. Results Plasma DNA levels (median: 54.0 ng / ml, interquartile range: 38.0-68.1 ng / ml) were significantly higher in esophageal cancer patients than in healthy controls (median: 18.5 ng / ml, quartile: 15.5-24.9 ng / ml), P <0.001. Plasma DNA levels were 37.0 (27.2-46.2) ng / ml, 53.0 (41.4-63.7) ng / ml and 66.3 (55.9-81.8) ng / ml respectively in stage IIa, IIb and III-IV. Ⅲ ~ Ⅳ was significantly higher than Ⅱ a ~ Ⅱ b period (P = 0.003). Plasma DNA levels in groups IIa and IIb were significantly higher than those in healthy controls (P <0.001). Plasma DNA contents were 32.3 (24.2-55.1) ng / ml, 52.9 (42.5-69.6) ng / ml and 65.0 (57.7-88.6) ng / ml respectively in high, moderately differentiated and poorly differentiated groups, In the high and middle differentiation group (P = 0.010). With 32.3 ng / mL as the cutoff value, the diagnostic sensitivity of plasma DNA was 91.2% with a specificity of 90.0%. The area under the ROC curve was 0.959 (95% CI 0.915-1.000), superior to serum CEA. Conclusion The detection of plasma DNA on esophageal cancer screening, early diagnosis, to determine the invasion and metastasis of tumor has an important value.