| Objective:In the contemporary world, lung cancer is one of harmful disease to human health and human life. The morbidity and mortality are keep rise, and the patient of lung cancer have poor prognosis. Early diagnosis and early treatment are closely related to improve the survival. With the rapid development of imaging and pathology testing improved the diagnosis of lung cancer, in addition to a variety of tumor markers plays an important role in the diagnosis of lung cancer.Pleural effusion is a common clinical disease, according to the nature of fluid divided into transudative pleural effusion and exudative pleural effusion. In China, the most common disease lead to exudative pleural effusion are tuberculous pleural effusion and malignant pleural effusion, but there are some difficulties in differential diagnosis of this two kind of disease. Tumor markers, such as CEA, expressed in two kind of pleural effusion with lack of specificity. Therefore, we need to find a more specificity tumor marker to solve this clinical problem.Diagnosis of solid tumors is dependent on the pathological. The common method for obtaining lung tissue samples include: bronchoscopy, percutaneous puncture under CT guidance, thoracoscopy, mediastinoscopy, open lung biopsy and lobectomy. However, the above methods are difficult to apply in clinical work, because these methods are invasive testing, patients undergo more suffering, more complications, higher medical costs, and difficult to carry out in some medical institutions. In recent years, pleural effusion sediment pathological examination has become an important means of diagnosis of malignant pleural effusion.The aim of this study was to detect the soluble form of Carbonic Anhydrase IX level(s-CAIX) in the serum of lung cancer patients and healthy. And s-CAIX levels in pleural effusion of patients with tuberculous pleurisy and lung cancer with pleural metastasis. Detection the expression of s-CIAX in pleural effusion sediment of lung cancer patients and non-cancer patients. Discussion the different between the two serum groups and two pleural effusion groups, and to evaluation the significance of s-CAIX detection in the diagnosis of lung cancer, and the significance of differential diagnosis of benign and malignant pleural effusions. Discussion the different of s-CAIX level between serum and pleural effusion of the lung cancer patients with pleural metastasis and their correlation. Analyze whether there are differences in the serum s-CAIX level among different pathological types and TNM staging of lung cancer. Explore the relevance of CAIX expression in the pleural effusion sediment and the level in the pleural effusion.Method:1、The serum s-CAIX level was determined by ELISA in 47 cases of experimental group and 31 cases of the control group. 2、The pleural effusion s-CAIX level was determined by ELISA in 29 cases of experimental group and in 27 cases of the control group. 3、The expression of CIAX in the pleural effusion sediment was determined by immunohistochemistry in 21 malignant pleural effusion of lung cancer patients with pleural metastasis and 6 non-cancer patients pleural effusion.Result:1、The serum s-CAIX level is 290.12(215.53,550.24) pg/ml in experimental group, The serum s-CAIX level is 56.54(41.83,94.18) pg/ml in control group. The s-CAIX serum level in the experimental group is significantly higher than in the control group(P <0.05). 2、In the experimental group of serum, the s-CAIX level in different pathological types of lung cancer: squamous cell carcinoma, adenocarcinoma, small cell lung cancer groups s-CAIX level are 550.24(271.72,1142.93) pg/ml, 257.39(202.39,404.32) pg/ml, 529.36(241.49,933.34) pg/ml, the differences of serum s-CAIX level among the three groups have statistically significant(P <0.05). Compare the serum s-CAIX level among different pathological types: squamous cell carcinoma and small cell carcinoma are higher than adenocarcinoma group, the difference is statistically significant(P <0.05), the serum s-CAIX level between squamous cell carcinoma and small cell carcinoma are similar, and there are no statistically significant differences between the two groups(P> 0.05). 3、Compare serum s-CAIX levels of lung cancer patient with different TNM staging : serum s-CAIX levels of Ⅰ+Ⅱperiod lung cancer patients is 330.10(250.97,754.65)pg/ml, Ⅲ+ Ⅳperiod lung cancer patients serum s-CAIX level is 290.12(205.17,525.82)pg/ml, There is no statistically significant differences(P>0.05). 4、With pathology as the gold standard, draw a ROC curve of serum s-CAIX level in the diagnosis of lung cancer. The area under the curve is 0.961. Serum s-CAIX level for diagnosis of lung cancer have significant meaning(P < 0.05). When serum s-CAIX level was 115.115pg/ml, it have a good specific and sensitivity degrees at 95.7% and 90.3%,respectively. 5、Pleural effusion s-CAIX level is(241.61±136.74)pg/ml in the experimental group patients, compare with(136.61±108.07)pg/ml in the control. Pleural effusion s-CAIX level in experimental group is significantly higher than the control group, the difference is statistically significant(P < 0.05). 6、With pathology as the gold standard, draw ROC curves of pleural effusion s-CAIX level in the diagnosis of lung cancer. The area under the curve is 0.761. Pleural effusion s-CAIX level for diagnosis of lung cancer have significant meaning(P < 0.05) When pleural effusion s-CAIX level is 109.135pg/ml, the specific and sensitivity are 92.3% and 58.3%, respectively. 7、The serum s-CAIX level of lung cancer patients with malignant pleural effusion, who caused by pleural metastasis, is 260.03 ± 159.92 pg / ml, the pleural effusion s-CAIX level is 213.10±175.14 pg/ml; The serum s-CAIX level is higher than pleural effusion, but the difference has no statistically significant(P> 0.05). The correlation coefficient between serum s-CAIX level and pleural effusion s-CAIX level of lung cancer patients with pleural metastasis is r =-0.057, close to zero, no significant correlation between the two(P> 0.05). 8、The CAIX expression in 66.67% pleural effusion sediment, caused by pleural metastasis, there no CAIX expression in benign pleural effusion sediment,the specificity is 100%. 9、The correlation coefficient between CAIX expression in malignant pleural effusion sediment and s-CAIX level in malignant pleural effusion is r =-0.03, P = 0.926. No significant correlation between the two. The correlation coefficient between CAIX expression in malignant pleural effusion sediment and s-CAIX level in serum is r=0.11,P=0.778. No significant correlation between the two.Conclusion:1、The detection of the serum s-CAIX level may have certain application value in dagnosis lung cancer. 2、There are obvious difference of serum s-CAIX levels among different types of pathological types, suggesting that serum s-CAIX is helpful for distinguish pathological types of lung cancer. 3、Serum s-CAIX level no significant correlation with tumor stage. 4、The detection of the pleural effusion s-CAIX level may have certain application value to detection for malignant pleural effusion. 5、Malignant pleural effusion s-CAIX level, which caused by pleural metastasis of lung cancer, has no significant correlation with serum s-CAIX level. 6、The detection of CAIX expression in pleural fluid sediment may have certain application value in identification of benign and malignant pleural sediment. 7、CAIX expression in malignant pleural effusion sediment was no significantly correlated with pleural effusion s-CAIX level and serum s-CAIX level. Body fluids s-CAIX come from tissues CAIX, which cleavage the extracellular part by proteolytic, but it has nothing to do with the tissues CAIX expression. |
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