赣南医学院学报2024，Vol.44Issue(9) ：885-890.DOI:10.3969/j.issn.1001-5779.2024.09.003

外周ALP、钙离子和D-二聚体浓度对乳腺癌骨转移的预测价值

Predictive value of serum alkaline phosphatase,calcium and D-dimer concentrations on bone metastasis of breast cancer

张磊 康佳 钱晶 何泽来
赣南医学院学报2024，Vol.44Issue(9) ：885-890.DOI:10.3969/j.issn.1001-5779.2024.09.003
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外周ALP、钙离子和D-二聚体浓度对乳腺癌骨转移的预测价值

Predictive value of serum alkaline phosphatase,calcium and D-dimer concentrations on bone metastasis of breast cancer

张磊 1康佳 1钱晶 1何泽来1
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作者信息

  • 1. 蚌埠医科大学第一附属医院放疗科,安徽 蚌埠 233004
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摘要

目的:探讨外周血碱性磷酸酶(Alkaline phosphatase,ALP)、钙离子(Ca2+)和D-二聚体浓度对乳腺癌骨转移的预测价值.方法:回顾性分析2022年7-12月蚌埠医科大学第一附属医院收治的乳腺癌患者111例,根据骨扫描和磁共振检查结果分为无骨转移组(63例)、局限性骨转移组(骨转移病灶≤5个)(15例)和广泛性骨转移组(骨转移病灶＞5个)(33例).采用单因素方差分析、Spearman相关性分析和ROC曲线分析各指标对乳腺癌骨转移的预测价值.结果:3组患者ALP和D-二聚体差异均有统计学意义(P＜0.05),Ca2+浓度差异无统计学意义(P＞0.05).进一步两两比较结果显示,广泛性骨转移组ALP明显高于无骨转移组,局限性骨转移组、广泛性骨转移组D-二聚体均明显高于无骨转移组,差异均有统计学意义(P＜0.05);无骨转移组与局限性骨转移组ALP、局限性骨转移组与广泛性骨转移组ALP及D-二聚体差异无统计学意义(P＞0.05).Spearman检验结果显示,ALP(r=0.294,P=0.001)和D-二聚体(r=0.593,P＜0.001)与骨转移严重程度呈正相关,Ca2+与骨转移严重程度无相关性(r=0.012,P=0.902).外周血ALP和D-二聚体水平诊断乳腺癌骨转移的AUC分别为0.653(95%CI:0.549～0.757)和 0.841(95%CI:0.753～0.929),最佳截断值分别为:73.500 U·L-1 和 0.635 mg·L-1,敏感度分别为58.333%、77.083%,特异度分别为72.718%、93.939%.两者联合预测乳腺癌骨转移的AUC最高,为0.847(95%CI:0.764～0.930),敏感度77.083%,特异度95.385%.根据方差分析结果表明,ALP与D-二聚体联合诊断乳腺癌骨转移的敏感度较高,能够更好地识别骨转移病例;特异度方面,两者联合相较于D-二聚体没有显著的优势;D-二聚体的约登指数较高.结论:外周血ALP和D-二聚体浓度对于预测乳腺癌骨转移有一定的预测价值,作为骨标志物与乳腺癌骨转移具有相关性,且单选择D-二聚体可作为预测指标.

Abstract

Objective:To study the predictive value of serum alkaline phosphatase(ALP),calcium(Ca2+)and D-Dimer concentrations in bone metastasis of breast cancer.Methods:A retrospective analysis was conducted on 111 breast cancer patients admitted to The First Affiliated Hospital of Bengbu Medical University from July to December in 2022.According to the results of ECT bone scan and MRI examination,they were divided into a non-bone metastasis group(63 cases),a limited bone metastasis(bone metastases≤5,15 cases)and an extensive bone metastases group(bone metastases＞5,33 cases).One-way analysis of variance,Spearman correlation analysis and ROC curve were used to analyze the predictive value of each index on bone metastasis of breast cancer.Results:The differences in ALP and D-Dimer among the three groups of patients were statistically significant(P＜0.05).But the difference in Ca2+concentration was not statistically significant(P＞0.05).Further pairwise comparison results showed that the ALP concentration in extensive bone metastases group was significantly higher than that in non-bone metastasis group(P＜0.05).The D-Dimer concentration in limited bone metastasis group and extensive bone metastases group was significantly higher than that in non-bone metastasis group(P＜0.05).There was no statistically significant difference in ALP concentration between non-bone metastasis group and limited bone metastasis group.There was also no significant difference in ALP and D-Dimer concentrations between limited bone metastasis group and extensive bone metastases group(P＞0.05).Spearman test results showed that ALP(r=0.294,P=0.001)and D-Dimer concentrations(r=0.593,P＜0.001)were positively correlated with the severity of bone metastasis,while Ca2+concentration had no correlation with the severity of bone metastasis(r=0.012,P=0.902).The area under ROC curve(AUC)of ALP and D-Dimer concentrations for diagnosis of bone metastasis of breast cancer was 0.653(95% CI:0.549-0.757)and 0.841(95% CI:0.753-0.929)respectively.The optimal cutoff values were 73.500 U·L-1 and 0.635 mg·L-1,the sensitivities were 58.333% and 77.083%,and the specificities were 72.718% and 93.939% respectively.The combined prediction of bone metastasis had the highest AUC of 0.847(95% CI:0.764-0.930),with a sensitivity of 77.083% and a specificity of 95.385% .According to the results of the analysis of variance,the combined use of ALP and D-Dimer for diagnosing breast cancer bone metastases had higher sensitivity and is more effective in identifying cases of bone metastases.In terms of specificity,the combined approach did not show a significant advantage over D-Dimer alone,D-Dimer had a higher Youden's index.Conclusion:The concentrations of serum ALP and D-Dimer have certain predictive value for predicting bone metastasis of breast cancer.As bone markers,ALP and D-Dimer concentrations are correlated with bone metastasis of breast cancer.D-Dimer can be considered as the only prediction index to be selected.The concentration of Ca2+is not correlated with bone metastasis of breast cancer.

关键词

乳腺癌/骨转移瘤/碱性磷酸酶/钙离子/D-二聚体

Key words

Breast cancer/Bone metastases/Alkaline phosphatase/Calcium/D-Dimer

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出版年

2024
赣南医学院学报
赣南医学院

赣南医学院学报

影响因子：0.622
ISSN：1001-5779
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