作者：李斯靖，李晓枫

单位：珠海市中西医结合医院 外科，广东 珠海 510000

Authors:  LI Sijing, LI Xiaofeng

Unit:  Department of Surgery, Zhuhai Integrated Traditional Chinese and Western Medicine Hospital, Zhuhai 510000, Guangdong, China

摘要：

目的   观察血清外泌体mir-17、mir-23a表达水平，探究其对结肠癌的诊断价值。方法  收集2017年12月-2018年12月本院收治结肠癌患者65例为研究对象，另取正常健康体检者65例为对照组，采集所有受试者外周血血清，提取血清外泌体，采用实时荧光定量PCR(RT-qPCR)法检测血清外泌体mir-17、mir-23a表达水平;分析血清外泌体mir-17、mir-23a表达水平与结肠癌患者临床病理参数的关系;绘制ROC曲线分析mir-17、mir-23a联合检测对结肠癌的诊断价值;Logistic回归分析影响结肠癌患者发生的危险因素。结果  与对照组比较，结肠癌患者血清外泌体中mir-17、mir-23a表达水平显著升高;mir-17、mir-23a表达水平结肠癌患者年龄、性别、病理类型、脉管浸润、CEA水平无关，与TNM分期、分化程度、淋巴结转移有关(P<0.05);血清外泌体mir-17、mir-23a表达水平诊断结肠癌患者的AUC为0.775、0.802，特异度为76.90%、81.50%，灵敏度为75.40%、80.00%; 二者联合诊断结肠癌患者的AUC为0.884，特异度为65.50%，灵敏度为93.80%。Logistic分析结果显示，淋巴结转移、mir-17、mir-23a表达水平是影响结肠癌发生的独立危险因素。结论  mir-17、mir-23a在结肠癌患者血清外泌体中显著高表达，与结肠癌分化程度及淋巴转移有关，二者联合检测可提高对结肠癌诊断的准确度及灵敏度，可能对结肠癌早期诊断有一定参考意义。

关键词： MicroRNA-17; MicroRNA-23a; 结肠癌; 外泌体; 诊断价值

Abstract：

Objective  To observe the expression levels of mir-17 and mir-23a in serum exosomes and explore their diagnostic values for colon cancer. Methods  65 patients with colon cancer admitted to our hospital from December 2017 to December 2018 were selected as the study subjects, and 65 healthy people as the control group. Peripheral blood serum was collected from all subjects and serum exosomes were extracted. Real-time fluorescence quantitative PCR (RT-qPCR) was used to detect the expression levels of mir-17 and mir-23a in serum exosomes, the relationships between the expressions of mir-17 and mir-23a in serum and the clinicopathological parameters of patients with colon cancer were analyzed, the ROC curve was drawn to analyze the diagnostic value of combined detection of mir-17 and mir-23a for colon cancer, Logistic regression analysis was used to analyze the risk factors of colon cancer. Results  Compared with the control group, the levels of mir-17 and mir-23a in serum exosomes of patients with colon cancer were significantly increased (P<0.05). The expression levels of mir-17 and mir-23a were not related to age, sex, pathological type, vascular invasion and CEA level (P>0.05), but were related to TNM stage, differentiation degree and lymph node metastasis (P<0.05). The AUC of serum exosome mir-17 and mir-23a was 0.775 and 0.802, the cut-off value was 3.523 and 3.615, the specificity was 76.90% and 81.50%, and the sensitivity was 75.40% and 80.00%. The AUC of colon cancer patients diagnosed by the combination of the two was 0.884, the specificity of 65.50% and the sensitivity of 93.80%. Logistic regression analysis showed that lymph node metastasis, mir-17 and mir-23a expression levels were independent risk factors for colon cancer (OR =1.764, 95%CI: 1.452-2.143; OR =1.598, 95%CI: 1.275-2.003; OR =1.685, 95%CI: 1.428-1.988; P< 0.05). Conclusion  Mir-17 and mir-23a are highly expressed in serum exosomes of patients with colon cancer, which are related to the degree of differentiation and lymphatic metastasis of colon cancer. The combined detection of the two methods can improve the AUC and sensitivity in the diagnosis of colon cancer, which may have some reference significance for early diagnosis of colon cancer.

Key Words:  MicroRNA-17; MicroRNA-23a; Colon cancer; Exosome; Diagnostic value