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    血清维生素D结合蛋白、FGF23、Klotho与乳腺癌骨转移的相关性分析

    Correlation Analysis of Serum Vitamin D-Binding Protein, FGF23, Klotho and Bone Metastasis of Breast Cancer

      摘要
    • 摘要:
      目的 骨转移是乳腺癌常见的并发症之一，严重影响患者的生存和预后。本研究旨在探究血清维生素D结合蛋白（vitamin D-binding protein，VDBP）、成纤维细胞生长因子23（fibroblast growth factor 23，FGF23）和Klotho蛋白在乳腺癌骨转移中的表达及临床意义。
      方法 收集95例来自本院2019-08-01至2021-08-01的女性乳腺癌患者作为研究对象，经影像学和组织病理学方式诊断是否发生骨转移，将患者分为骨转移组36例，非骨转移组59例。分析两组患者的临床病理特征；采集患者外周血样本，通过ELISA对血清中VDBP、FGF23和Klotho进行定量分析；使用Spearman相关分析进行指标间的关联性分析；Logistic回归分析乳腺癌发生骨转移的影响因素；ROC曲线分析血清VDBP、FGF23和Klotho水平预测乳腺癌发生骨转移的价值。
      结果 骨转移和非骨转移乳腺癌病理分级比较有统计学意义（P＜0.05）。骨转移和非骨转移乳腺癌患者血清中VDBP、FGF23及Klotho的水平依次为：（80.35±29.34）和（115.18±48.69）ng/mL、（658.35±201.19）和（405.36±154.42）pg/mL以及（155.82±40.29）和（229.35±72.46）pg/mL，两组比较差异有统计学意义（P＜0.05）。Spearman相关性分析显示，骨转移乳腺癌患者血清中VDBP水平与乳腺癌病理分级相关（P＜0.05）；FGF23和Klotho水平与病理分级、是否骨痛以及转移部位有关（P＜0.05）。VDBP、FGF23和Klotho水平均为乳腺癌骨转移发生的独立影响因素（P＜0.05）。ROC曲线结果显示，VDBP、FGF23及Klotho预测乳腺癌患者发生骨转移的曲线下面积依次为：0.733、0.806、0.761，最佳截断值为：81.56 ng/mL、573.501 pg/mL和201.193 pg/mL；3个指标联合诊断的曲线下面积为0.820，高于单一指标诊断的曲线下面积。
      结论 血清VDBP、FGF23及Klotho水平可作为乳腺癌骨转移的参考指标，在乳腺癌骨转移的临床诊断上具有一定应用前景。

       

      Abstract:
      Objective Bone metastasis is one of the common complications of breast cancer patients, which seriously affects the survival and prognosis of patients. The aim of this study is to investigate the expression and clinical significance of serum vitamin D-binding protein(VDBP), fibroblast growth factor 23(FGF23)and Klotho in breast cancer bone metastases.
      Methods Ninety-five female breast cancer patients from our hospital from 2019-08-01 to 2021-08-01 were collected as the research subjects, the bone metastasis was diagnosed by imaging and histopathology, and the 95 patients were grouped into 36 cases with bone metastasis and 59 cases without bone metastasis. Analysis of clinicopathological features of patients in both groups; Patient peripheral blood samples were collected, the quantitative analysis of VDBP, FGF23 and Klotho in serum was carried out by ELISA; the correlation between the indicators was analyzed using the Spearman correlation coefficient; Logistic regression analyzed the influencing factors of bone metastasis in breast cancer patients; the value of serum VDBP, FGF23 and Klotho levels in predicting bone metastasis in breast cancer patients was analyzed by ROC curve.
      Results There was a significant comparison of pathological grades in patients with bone metastasis and non-bone metastasis breast cancer(P < 0.05). The serum levels of VDBP, FGF23 and Klotho in patients with bone metastases and non-bone metastases were as follows: (80.35±29.34)and(115.18±48.69) ng/mL, (658.35 ± 201.19) and (405.36 ± 154.42) ng/mL, (155.82 ± 40.29) and (229.35 ± 72.46) ng/mL, and the differences were statistically significant between the two groups(P < 0.05). Spearman correlation analysis showed that VDBP in serum of breast cancer patients with bone metastases was correlated with the pathological grade of breast cancer (P < 0.05);the levels of FGF23 and Klotho were related to pathological grade, bone pain, visceral metastasis and metastasis site(P < 0.05). VDBP, FGF23 and Klotho levels were independent factors influencing the occurrence of bone metastasis in breast cancer(P < 0.05). The ROC curve results showed that the areas under the curve of VDBP, FGF23 and Klotho for predicting bone metastasis in breast cancer patients were: 0.733, 0.806, 0.761, and the best cut-off values were: 81.56 ng/mL, 573.501 pg/mL and 201.193 pg/mL. The area under the curve of the combined diagnosis of the three indicators was 0.820, which is higher than the area under the curve of the diagnosis of a single indicator.
      Conclusions The serum levels of VDBP, FGF23 and Klotho can be used as reference indicators for bone metastasis of breast cancer, and have certain application prospects in the clinical diagnosis of bone metastasis of breast cancer.

       

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