骨肉瘤患者血浆sST2水平及临床意义

目的 探讨骨肉瘤患者血浆sST2水平及其临床意义。方法 收集本院2012年1月至2016年12月骨肉瘤患者术前血浆标本68例及术后血浆标本33例，选取同期75例健康体检者的血浆标本作对照。采用酶联免疫吸附法检测以上样本的sST2水平，比较骨肉瘤患者术前与健康体检者的血浆sST2水平差异及骨肉瘤手术前后血浆sST2水平的变化情况，采用受试者工作特征曲线（ROC）评价血浆sST2水平在骨肉瘤早期诊断中的效能；进一步分析骨肉瘤患者治疗前血浆sST2水平与临床病理特征（性别、年龄、肿瘤部位、Enneking分期、病理亚型和AKP水平）的关系。结果 68例骨肉瘤患者术前血浆sST2水平为（392.71±176.93）pg／ml，高于75例健康体检者的（67.61±32.47）pg／ml（P<0.05），33例骨肉瘤患者术后血浆sST2水平为（169.09±91.43）pg／ml，低于术前的（412.15±182.44）pg／ml，差异有统计学意义（P<0.05）；ROC曲线分析显示血浆sST2水平诊断骨肉瘤的曲线下面积为0.994（95%CI：0.986～0.998），取截断值为147.50 pg／ml的敏感度和特异度分别为95.59%和97.33%；骨肉瘤术前血浆sST2水平与性别、年龄、肿瘤部位及病理亚型均无关，但与Enneking分期和AKP水平有关，其中Ⅲ期的血浆sST2水平高于Ⅱ期，AKP升高者的血浆sST2水平高于AKP正常者，差异有统计学意义（P<0.05）。结论 骨肉瘤患者血浆sST2升高且术后该指标水平降低，且均与Enneking分期和AKP水平有关，可能参与了骨肉瘤的发生发展，对骨肉瘤诊断及病情评估有一定价值。

Clinical significance of plasma sST2 levels in patients with osteosarcoma

Objective To investigate the clinical significance of plasma sST2 levels in patients with osteosarcoma. Methods From January 2012 to December 2016， preoperative plasma samples from 68 patients and postoperative plasma samples from 33 patients with osteosarcoma were collected. The plasma samples of 75 healthy subjects were selected as control. The levels of sST2 in the above samples were detected by enzyme linked immunosorbent assay. The difference of plasma sST2 levels between the preoperative samples and the healthy subjects and the changes of plasma sST2 levels before and after the operation of osteosarcoma were compared. The receiver operating characteristic curve （ROC） was used to evaluate the effectiveness of plasma sST2 levels in the early diagnosis of osteosarcoma. The relationship between plasma sST2 levels and clinicopathological features （sex， age， tumor site， Enneking stage， pathological subtype and AKP level） in osteosarcoma patients was further analyzed. Results The level of plasma sST2 in 68 patients with osteosarcoma was （392.71±176.93） pg／ml，higher than （67.61±32.47） pg／ml of 75 healthy subjects （P<0.05）. The postoperative level of plasma sST2 in 33 patients with osteosarcoma was （169.09±91.43） pg／ml， lower than （412.15±182.44） pg／ml of preoperative plasma specimens， and the difference was statistically significant （P<0.05）. ROC curve analysis showed that the area under the curve of sST2 in the diagnosis of osteosarcoma was 0.994 （95%CI：0.986-1.002）. When the cut-off value was 147.50 pg／ml， the sensitivity and specificity were 95.59% and 97.33%， respectively. Preoperative plasma sST2 levels are independent of gender， age， tumor location and pathological subtypes， but related with the Enneking stage and the level of AKP. The plasma level of sST2 was higher in stage Ⅲ than in stage Ⅱ， and compared with patients with the normal AKP， the plasma level of sST2 increased in patients with high-level AKP （P<0.05）. Conclusion The plasma sST2 of patients with osteosarcoma increased and its level decreased after operation，and was associated with Enneking stage and AKP level. Preoperative level of sST2 may be related to the occurrence and development of osteosarcoma，which has a certain value in the evaluation and clinical diagnosis of osteosarcoma.