The Diagnostic Value Of Heat Shock Protein 90α In Malignant Pleural Effusion

BackgroundMalignant pleural effusion（MPE）is a common malignancy complication,indicating advanced cancer.A Clear diagnosis of MPE is of great significance for evaluating tumor staging and guiding the formulation of treatment plans.Currently,tumor markers commonly used in clinical diagnosis and treatment include carcinoembryonic antigen（CEA）,cytokeratin 19 fragment（CYFRA21-1）,neuron-specific alkene Alcoholase（NSE）,but the above classical tumor markers cannot be used to diagnose lung cancer independently.Heat shock protein 90α（Heat shock protein 90α,Hsp90α）is highly expressed in a variety of tumors,and is a relatively new tumor marker,but there are few studies on Hsp90α in differentiating of benign and malignant pleural effusions at home and abroad.In this study,the diagnostic performance of Hsp90α in serum and pleural effusion was investigated,alone or in combination with CEA,PE/S CEA,CYFRA21-1,NSE and provide some reference for differentiating benign and malignant pleural effusions.ObjectiveTo evaluate the diagnostic value of Hsp90α in malignant pleural effusion.MethodsIn this study,103 Pleural effusions（PE）patients hospitalized in the Department of Respiratory Medicine,The First Affiliated Hospital of Anhui Medical University from S eptember 2020 to July 2021 were collected,including 48 patients with MPE and 55 patients with benign pleural effusion（BPE）.The concentrations of Hsp90α in serum and pleural fluid were determined by Enzyme-Linked immunosorbent assay（ELISA）,while concentrations of CEA,CYFRA21-1 and NSE in serum and pleural fluid were tested by chemiluminescence immunoassay.The area under the ROC curve was calculated to evaluate the identification ability of Hsp90α,CEA,PE/S CEA,CYFRA21-1 and NSE,and the combined detection of pleural effusion was also evaluated.Results1.The concentrations of Hsp90α in serum and pleural fluid of MPE patients were72.61（58.95-119.21）ng/mL and 200.30（115.05-275.16）ng/mL,respectively.The concentrations of Hsp90α in serum and pleural fluid of BPE patients were79.65（52.14-116.87）ng/mL and 103.39（47.57-175.32）ng/mL,respectively.There was no significant difference in serum Hsp90α concentration between the two groups（P>0.05）.But in pleural effusion,the difference in Hsp90α concentration between the two groups was statistically significant（P<0.001）.The results of this study suggested that the pleural effusion concentrations of Hsp90α were higher in MPE than BPE.2.The serum concentrations of CEA,CYFRA21-1 and NSE in the MPE group were significantly higher than those in the BPE group,with a statistically significant difference（P<0.001）.The pleural effusion concentrations of CEA,CYFRA21-1 and NSE in the MPE group were higher than those in the BPE group,with a statistically significant difference（P<0.05）.3.There was no significant difference in the concentration of pleural fluid Hsp90α in MPE caused by different types of tumors（P>0.05）.Among patients with lung cancer related MPE,there was no significant correlation between the concentrations of Hsp90αin pleural fluid of patients with or without distant organ metastasis and lymph node metastasis（P>0.05）.The concentrations of Hsp90α in pleural fluid of patients with small cell carcinoma was higher than that of patients with adenocarcinoma and squamous cell carcinoma（P<0.05）.4.At the cut-off value was 175.785 ng/mL,the sensitivity and specificity of Hsp90α in pleural fluid for diagnosing MPE were 62.50%,76.40%.The diagnostic value of Hsp90α in pleural effusion is lower than that of CEA,which is the most commonly used in clinical practice.The AUC of serum and pleural fluild CEA are 0.736 and 0.883,respectively,which are higher than 0.710 of pleural fluild Hsp90α.5.In the comparison of the diagnostic efficacy of pleural effusion tumor markers for MPE,PE/S CEA had the highest sensitivity in diagnosing MPE（87.50%）,and the combined detection of Hsp90α and PE/S CEA in pleural effusion and the combined detection of Hsp90α,CEA and PE/S CEA in pleural effusion had the highest specificity（98.00%）,the combined detection of Hsp90α and PE/S CEA had the highest diagnostic value with an AUC of 0.943.ConclusionHsp90α can be used as a potential tumor marker to identify MPE and BPE.The combined detection of Hsp90α with CEA,PE/S CEA,and CYFRA21-1can improve its sensitivity and specificity of the diagnosis of MPE.