| BackgroundIn China,liver cancer is one of the malignant tumors with high morbidity and mortality.Because the early symptoms are not obvious,most patients have been found in the middle and late stage,and missed the best time for treatment.Primary carcinoma of the liver can be divided into hepatocellular carcinoma(HCC),biliary cell carcinoma and mixed cell type according to pathological types,90%of which are hepatocellular carcinoma(HCC).Therefore,HCC is our research object.Currently,alpha-fetoprotein(AFP)is still the most commonly used marker of liver cancer in clinical practice,but AFP has certain defects in sensitivity and specificity.As a key enzyme in the process of glucose metabolism,enolase(ENO1)plays an important role in the process of cell energy metabolism.In addition,it also has a variety of biological functions related to intracellular localization.In recent years,a large number of studies have confirmed that the change of its expression level is related to a variety of diseases,especially the occurrence and development of tumors.Previous studies have confirmed that high expression of ENO1 also exists in liver cancer tissues compared with normal adjacent liver tissues,and the high expression of ENO1 promotes the proliferation,invasion,migration and dedifferentiation of tumor cells,and inhibits the apoptosis of tumor cells.Therefore,we proposed the hypothesis that high expression of ENO1 may also exist in the serum of liver cancer patients,and it is closely related to tumor progression.ENO1 is expected to be a potential indicator for the diagnosis and monitoring of HCC.Purpose1.Whether there is also high expression of ENO1 in the blood of patients with hepatocellular carcinoma;2.Whether there is a correlation between the changes of ENO1 in the serum of patients and the clinical and pathological grades of HCC;3.Analysis of the diagnostic value of ENO1 in HCC:Compare with AFP andestablish a joint detection model to verify whether ENO1 can be used as a new blood indicator for the diagnosis of HCC;4.Whether the level of ENO1 in patients with different degrees of liver fibrosis is different in blood.Objective and methodsSerum samples from 90 patients with hepatocellular carcinoma,45 patients with cirrhosis,and 45 patients with liver fibrosis were taken from the Department of Hepatology,Hepatobiliary Surgery,and Oncology of the PLA General Hospital and PLA 305 Hospital from October 2017 to August 2019 Of the patients admitted,45 healthy control specimens were taken from the health checkups of the medical examination center.Collect the general data and relevant clinical information of the test subjects,use the ELISA kit to detect the ENO1 concentration in serum,and analyze the test results statistically.To investigate whether ENO1 is elevated in the blood of patients with hepatocellular carcinoma.Then the patients with hepatocellular carcinoma were further subdivided to explore the relationship between the ENO1 concentration level and the stage and grade of HCC.Finally,the diagnostic value analysis of ENO1 is compared with the most commonly used AFP in clinical practice and a joint detection model is established to explore whether ENO1 can be used as a new blood index for the auxiliary diagnosis of hepatocellular carcinoma.Result1.The level of ENO1 in the HCC group was 74.40(27.27,122.27)ng/ml,significantly higher than that in the LC group(U=1081,Z=-4.406,P<0.01),LF group(U=579.5,Z=-6.747,P<0.01),and NC group(U=402.0,Z=-7.576,P<0.01).2.The concentration of ENO1 in LF group was lower than that in LC group(U=579.5,Z=-6.747,P<0.01),and higher than that in NC group(U=385.5,Z=-5.06,P<0.01).With the continuous evolution of liver tissues from normal to liver fibrosis and cirrhosis,the concentration of ENO1 showed a increasing trend.3.According to TNM staging group,group B(stage Ⅲ-Ⅳ)ENO1 concentration of 72.55 ng/ml(30.73,155.84)higher than that of group A(stage Ⅰ-Ⅱ)(24.46,94.88),59.75 ng/ml(U=695.5,Z=2.043,P<0.05).4.According to Edmondson grade group,group b(Ⅲ,Ⅳ)ENO1 concentration of 85.07 ng/ml(53.27,157.74)is higher than first division(Ⅰ,Ⅱ)(23.56,105.96),51.00 ng/ml(U=606,Z=2.405,P<0.05).5.Diagnostic value analysis:the AUC of ENO1 was 0.790(0.729～0.851).According to the index,54.9 ng/mL was selected as the cut-off.At this time,the sensitivity,specificity and accuracy of the diagnosis of HCC were 57.8%,88.9%and 76.44%,respectively.The positive predictive value and negative predictive value were 77.6%and 75.95%.The AUC of AFP was 0.823(0.760～0.886).When 10.05ng/mL was selected,the diagnostic sensitivity was 76.7%,specificity was 82.2%,accuracy was 80%,positive predictive value was 73.4%,and negative predictive value was 84.73%.6.The AUC of ENO1 combined with AFP diagnosis was 0.853(0.804～0.902),which was higher than that of any indicator detected separately.When parallel positive,the sensitivity and negative predictive values were 93.3%and 94.3%and the accuracy was 81%.When the series was positive,the specificity and positive predictive values were 97.0%and 90.5%.Compared with the single detection of ENO1 and AFP,the combined detection can further improve the diagnostic efficiency.ConclusionENO1 is a potential blood indicator related to the diagnosis of hepatocellular carcinoma and has high clinical application value.Its level is related to the clinical stage and pathological grade of the tumor.At the same time,ENO1 has the potential to be used as a dynamic monitoring index of liver fibrosis. |
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