支气管镜检查联合灌洗液microRNA-219-5p、microRNA-210对肺癌的诊断价值

Diagnostic value of bronchoscopy combined with microRNA-219-5p and microRNA-210 in bronchoalveolar lavage fluid for lung cancer

摘要:

目的 探讨支气管镜检查联合支气管肺泡灌洗液microRNA-219-5p（miR-219-5p）、microRNA-210（miR-210）对肺癌的诊断价值。方法 选取2022年3月—2025年3月南京市胸科医院收治的306例肺部占位性病变患者作为研究对象，经病理确诊后分为肺癌组（179例）和良性组（127例），另取同期该院100例健康体检者作为对照组。所有受试者行支气管镜检查并采集灌洗液，采用实时荧光定量聚合酶链反应检测miR-219-5p和miR-210表达。分析3组miRNA表达差异及与肺癌病理特征的关系，通过多因素一般Logistic回归模型明确独立诊断因素，并绘制受试者工作特征（ROC）曲线评估诊断效能。结果 肺癌组miR-219-5p相对表达量低于良性组和对照组（P <0.05），miR-210相对表达量高于良性组和对照组（P <0.05）；良性组miR-219-5p相对表达量低于对照组（P <0.05），miR-210相对表达量高于对照组（P <0.05）。肿瘤直径< 3 cm、TNM分期Ⅰ、Ⅱ期和中高分化、无淋巴结转移肺癌患者miR-219-5p相对表达量较高（P <0.05）。TNM分期Ⅰ、Ⅱ期和中高分化、无淋巴结转移肺癌患者miR-210相对表达量较低（P <0.05）。肺癌组支气管镜检查阳性率较高（P <0.05）。多因素一般Logistic回归分析结果显示：miR-210相对表达量高［O^R=1.745（95% CI：1.445，2.108）］、支气管镜检查阳性［O^R=14.916（95% CI：4.318，51.525）］是肺部占位性病变患者肺癌的独立危险因素（P <0.05）；miR-219-5p相对表达量高［O^R=0.002（95% CI：0.001，0.011）］是肺部占位性病变患者肺癌的独立保护因素（P <0.05）。ROC曲线结果分析，支气管镜检查、灌洗液miR-219-5p和miR-210联合诊断的曲线下面积为0.987（95% CI：0.976，0.998），敏感性为94.4%（95% CI：0.900，0.973），特异性为97.6%（95% CI：0.933，0.995）。结论 支气管镜检查联合灌洗液miR-219-5p和miR-210检测可显著提高肺癌诊断准确性，其表达水平与疾病进展密切相关，具有重要的临床辅助诊断价值。

Abstract:

Objective To investigate the diagnostic value of bronchoscopy combined with miR-219-5p and miR-210 expression levels in bronchoalveolar lavage fluid (BALF) for lung cancer.Methods A total of 306 patients with pulmonary space-occupying lesions admitted to the Nanjing Thoracic Hospital between March 2022 and March 2025 were enrolled and divided into a lung cancer group (n = 179) and a benign group (n = 127) based on pathological diagnosis. Another 100 healthy individuals undergoing health check-ups at the hospital were included as a control group. Bronchoscopy was performed in all subjects, and BALF was collected for detection of miR-219-5p and miR-210 using qRT-PCR. Differences in miRNA expression among groups and their associations with clinicopathological characteristics were analyzed. Multivariable logistic regression analysis was performed to identify independent factors for diagnosing lung cancer, and ROC curves were constructed to evaluate their diagnostic performance.Results The miR-219-5p level was significantly lower in the lung cancer group than in the benign and control groups (P < 0.05), while the miR-210 level was higher (P < 0.05). The benign group also showed decreased miR-219-5p and increased miR-210 expression compared with the control group (P < 0.05). Higher miR-219-5p levels were observed in patients with tumor diameter < 3 cm, TNM stage I-Ⅱ disease, moderately- to highly-differentiated tumors, and no lymph node metastasis (P < 0.05). The relative expression level of miR-210 was lower in lung cancer patients with TNM stage I-II disease, moderately- to highly-differentiated tumors, and no lymph node metastasis (P < 0.05). The positive rate of bronchoscopy findings was significantly higher in the lung cancer group (P < 0.05). Multivariable analysis indicated that a high miR-210 level [O^R = 1.745 (95% CI: 1.445, 2.108) ] and positive bronchoscopy findings [O^R = 14.916 (95% CI: 4.318, 51.525) ] were risk factors for lung cancer, whereas a high miR-219-5p level [O^R = 0.002 (95% CI: 0.001, 0.011) ] was an independent protective factor (P <0.05). The ROC curve analysis exhibited that the combination of bronchoscopy, miR-219-5p, and miR-210 yielded an area under the curve of 0.987 (95% CI: 0.976, 0.998), with a sensitivity of 94.4% (95% CI: 0.900, 0.973) and a specificity of 97.6% (95% CI: 0.933, 0.995).Conclusion The combination of bronchoscopy with BALF miR-219-5p and miR-210 significantly improves diagnostic accuracy for lung cancer. The levels of miR-219-5p and miR-210 correlate closely with disease progression, highlighting their clinical utility as auxiliary diagnostic markers.