摘要： 目的：探讨口腔鳞状细胞癌（oral squamous cell carcinoma，OSCC）患者血清中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin，NGAL）、甲壳质酶蛋白 40（chitinase protein 40，YKL-40）的水平在诊断和预后中的价值。方法：选取本院 2017 年 3 月—2020 年 9 月间收治的 114 例 OSCC 患者作为研究对象（OSCC 组），另选取同期 118 例本院良性肿瘤病变者作为对照组，酶联免疫吸附试验（enzyme-linked immunosorbent assay，ELISA）检测 2 组受试者血清 NGAL、YKL-40 的水平；通过受试者工作特征（receiver operating characteristic，ROC）曲线分析血清NGAL、YKL-40 水平在 OSCC 中的诊断价值；并收集 OSCC 患者出院后 3 年内的预后情况，使用 Kaplan-Meier 法分析OSCC 患者血清 NGAL、YKL-40 水平与其 3 年预后的关系；采用 Cox 比例风险回归模型分析影响 OSCC 患者出院 3 年预后的危险因素。结果：OSCC 组血清 NGAL、YKL-40 水平显著高于对照组（P<0.001）；血清 NGAL、YKL-40 及二者联合诊断 OSCC 的曲线下面积（area under the curve，AUC）分别为 0.716、0.744、0.791，其中联合诊断的 AUC 优于单独检测（P=0.008、0.047）；不同年龄、性别、吸烟史、发病部位的 OSCC 患者血清 NGAL、YKL-40 表达水平比较，差异无统计学意义（P>0.05）；TNM 分期Ⅲ~Ⅳ期、肿瘤直径≥3 cm、有淋巴结转移患者血清 NGAL、YKL-40 表达水平显著高于 TNM分期Ⅰ~Ⅱ期、肿瘤直径<3 cm、无淋巴结转移患者（P<0.001）；NGAL 低表达患者的 3 年生存率高于 NGAL 高表达患者，YKL-40 低表达患者 3 年生存率高于 YKL-40 高表达患者（P<0.05）；NGAL、YKL-40 是影响 OSCC 患者预后的危险因素（P<0.001）。结论：OSCC 患者血清 NGAL、YKL-40 水平均升高，二者对 OSCC 有一定的诊断价值，并且与患者预后有关。

关键词: 口腔鳞状细胞癌, 中性粒细胞明胶酶相关脂质运载蛋白, 甲壳质酶蛋白 40, 诊断, 预后价值

Abstract:  Objective: To investigate the diagnostic and prognostic value of neutrophil gelatinase-associated lipocalin (NGAL) and chitinase protein 40 (YKL-40) levels in patients with oral squamous cell carcinoma (OSCC). Methods: A total of 114 patients with OSCC admitted to our hospital from March 2017 to September 2020 were selected as the study objects (OSCC group), and 118 patients with benign tumor lesions in our hospital during the same period were selected as the control group. Serum levels of NGAL and YKL-40 were detected by enzym-linked immunosorbent assay (ELISA). The diagnostic value of serum NGAL and YKL-40 levels in OSCC was analyzed by receiver operating characteristic (ROC) curve. The prognosis of OSCC patients within 3 years after discharge was collected. Kaplan-Meier method was used to analyze the relationship between serum NGAL and YKL-40 levels and 3-year prognosis of OSCC patients. Cox proportional risk regression model was used to analyze the risk factors affecting the 3-year prognosis of OSCC patients. Results: Serum NGAL and YKL-40 levels in OSCC group were significantly higher than those in control group (P<0.001). The area under the curve (AUC) of serum NGAL, YKL- 40 and combined OSCC were 0.716, 0.744 and 0.791, respectively, and the AUC of combined diagnosis was better than that of single detection (P=0.008, 0.047). There was no significant difference in the expression levels of serum NGAL and YKL-40 in OSCC patients with different age, gender, smoking history and disease site (P>0.05). The expression levels of serum NGAL and YKL-40 in patients with TNM stage Ⅲ to Ⅳ , tumor diameter ≥3 cm and lymph node metastasis were significantly higher than those in patients with TNM stageⅠ to Ⅱ , tumor diameter <3 cm and no lymph node metastasis (P<0.001). The 3-year survival rate of patients with low expression of NGAL was higher than that of patients with high expression of NGAL, and the 3-year survival rate of patients with low expression of YKL-40 was higher than that of patients with high expression of YKL-40 (P<0.05). NGAL and YKL-40 were risk factors for the prognosis of OSCC patients (P<0.001). Conclusion: Serum levels of NGAL and YKL-40 were elevatedin OSCC patients, both of which had certain diagnostic value for OSCC and were related to the prognosis of patients.

Key words: oral squamous cell carcinoma, neutrophil gelatinase-associated lipocalin, chitinase protein 40, diagnosis; prognostic value

中图分类号: 

• R782

• R739.8