血清PDK1和SFRP4在非小细胞肺癌患者预后评估中的价值

doi:10.3969/j.issn.1673-8640.2026.09.006

摘要/Abstract

摘要：

目的探讨血清丙酮酸脱氢酶激酶1（PDK1）、分泌型卷曲相关蛋白4（SFRP4）与非小细胞肺癌（NSCLC）患者临床病理特征的相关性及其在预后评估中的价值。方法选取2020年5月—2022年5月保定市第二中心医院NSCLC患者104例（NSCLC组）、肺部良性疾病患者100例（良性疾病组）。收集所有患者的临床资料，并检测血清PDK1和SFRP4水平。对NSCLC患者随访3年，根据预后情况将其分为死亡组（46例）和生存组（58例）。采用Cox回归分析评估NSCLC患者预后的影响因素。采用受试者工作特征（ROC）曲线评估PDK1和SFRP4判断患者死亡的效能。采用Kaplan-Meier生存曲线分析NSCLC患者的生存情况。结果 NSCLC组血清PDK1水平显著高于良性疾病组（P<0.001），SFRP4水平显著低于良性疾病组（P<0.001）。不同TNM分期、分化程度和有无淋巴转移的NSCLC患者之间血清PDK1、SFRP4水平差异均有统计学意义（P<0.05），不同年龄、性别、组织学类型的NSCLC患者之间血清PDK1、SFRP4水平差异均无统计学意义（P>0.05）。与生存组比较，死亡组血清PDK1水平显著升高（P<0.001），SFRP4水平显著降低（P<0.001）。TNM分期Ⅲ期、有淋巴转移、血清PDK1升高、血清SFRP4降低均为NSCLC患者死亡的危险因素（P<0.05）。采用Logistic回归分析构建TNM分期、淋巴转移、PDK1、SFRP4判断NSCLC患者死亡的联合检测模型。血清PDK1和SFRP4单项检测和联合检测判断NSCLC患者死亡的曲线下面积（AUC）分别为0.820、0.817、0.912。PDK1高水平组3年生存率（29.27%）显著低于低水平组（71.43%）（Log-rank χ²=19.872，P<0.001）；SFRP4低水平组3年生存率（20.41%）显著低于高水平组（76.36%）（Log-rank χ²=23.141，P<0.001）。结论 NSCLC患者血清PDK1、SFRP4水平与肿瘤低分化、高TNM分期和淋巴转移有关。血清PDK1和SFRP4在NSCLC患者预后评估中有一定的价值，或可作为预后评估标志物。

关键词: 丙酮酸脱氢酶激酶1, 分泌型卷曲相关蛋白4, 临床病理特征, 预后, 非小细胞肺癌

Abstract:

Objective To investigate the correlation between serum pyruvate dehydrogenase kinase 1 （PDK1），secreted frizzled-related protein 4 （SFRP4） and the clinical pathological characteristics of patients with non-small cell lung cancer （NSCLC），as well as their value in prognosis assessment. Methods A total of 104 NSCLC patients （NSCLC group） and 100 patients with benign lung diseases （benign disease group） were enrolled from Baoding Second Central Hospital from May 2020 to May 2022. The clinical data were collected，and the levels of serum PDK1 and SFRP4 were determined. The NSCLC patients were followed up for 3 years，and they were classified into death group（46 cases）and survival group（58 cases）according to their prognosis outcomes. Cox regression analysis was used to evaluate the influencing factors of prognosis in NSCLC patients. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of PDK1 and SFRP4 in predicting patient mortality. The survival situation of NSCLC patients was analyzed using Kaplan-Meier survival curve. Results The serum PDK1 level in NSCLC group was higher than that in benign disease group（P<0.001），and the serum SFRP4 level was lower than that in benign disease group（P<0.001）. There was statistical significance in serum PDK1 and SFRP4 levels among NSCLC patients with different TNM stages，differentiation degrees and lymphatic metastasis（P<0.05）. There was no statistical significance in serum PDK1 and SFRP4 levels among NSCLC patients of different ages，genders and histological types（P>0.05）. Compared with survival group，the serum PDK1 level in death group was increased（P<0.001），and the serum SFRP4 level was decreased（P<0.001）. TNM stage Ⅲ， lymphatic metastasis，elevated serum PDK1 and decreased serum SFRP4 were all risk factors for death in NSCLC patients（P<0.05）. A combined determination model of TNM stage， lymphatic metastasis and serum PDK1 and SFRP4 was constructed using Logistic regression analysis. The areas under curves（AUC）of single and combined determination model of serum PDK1 and SFRP4 for determining the death of NSCLC patients were 0.820 and 0.817，respectively. The 3-year survival rate of high-level PDK1 group （29.27%） was lower than that of low-level group（71.43%）（Log-rank χ²= 19.872，P<0.001）；the 3-year survival rate of low-level SFRP4 group（20.41%）was lower than that of high-level group（76.36%）（Log-rank χ²= 23.141，P<0.001）. Conclusions The serum PDK1 and SFRP4 levels in NSCLC patients are related to tumor low differentiation，high TNM stage and lymphatic metastasis. Serum PDK1 and SFRP4 have certain value in prognosis assessment of NSCLC patients，and they may be prognostic markers.

Key words: Pyruvate dehydrogenase kinase 1, Secreted frizzled-related protein 4, Clinical pathological characteristic, Prognosis, Non-small cell lung cancer

中图分类号:

Q555

赵芳, 姜国荣, 史淑月, 肖剑, 马少林, 李润浦. 血清PDK1和SFRP4在非小细胞肺癌患者预后评估中的价值[J]. 检验医学, 2026, 41(9): 860-866.

ZHAO Fang, JIANG Guorong, SHI Shuyue, XIAO Jian, MA Shaolin, LI Runpu. Roles of serum PDK1 and SFRP4 in prognosis assessment of non-small cell lung cancer patients[J]. Laboratory Medicine, 2026, 41(9): 860-866.

图/表 7

参考文献 23

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组别	例数	PDK1/ （ng·mL^-1）	SFRP4/ （ng·mL^-1）
良性疾病组	100	3.73±1.53	65.41±20.70
NSCLC组	104	5.89±1.70	39.65±12.43
t值		9.526	10.823
P值		<0.001	<0.001

组别	例数	PDK1/ （ng·mL^-1）	SFRP4/ （ng·mL^-1）
良性疾病组	100	3.73±1.53	65.41±20.70
NSCLC组	104	5.89±1.70	39.65±12.43
t值		9.526	10.823
P值		<0.001	<0.001

临床病理特征	例数	PDK1/（ng·mL^-1）	SFRP4/（ng·mL^-1）	临床病理特征	例数	PDK1/（ng·mL^-1）	SFRP4/（ng·mL^-1）
年龄				TNM分期
<60岁	48	5.63±1.78	40.56±12.42	Ⅰ~Ⅱ期	58	5.48±1.44	43.17±13.57
≥60岁	56	6.11±1.63	38.87±12.44	Ⅲ期	46	6.41±2.03	35.21±10.99
t值		1.435	0.691	t值		2.730	3.225
P值		0.154	0.491	P值		0.007	0.002
性别				分化程度
男	62	5.98±1.73	38.26±12.24	中/高分化	63	5.52±1.50	42.83±13.59
女	42	5.76±1.66	41.70±12.71	低分化	41	6.46±2.01	34.76±10.65
t值		0.647	1.385	t值		2.727	3.212
P值		0.519	0.169	P值		0.008	0.002
组织学类型				淋巴转移
腺癌	88	5.86±1.74	39.75±12.39	无	51	5.42±1.42	43.11±13.24
鳞癌	16	6.05±1.48	39.10±12.65	有	53	6.34±1.97	36.32±11.65
t值		0.410	0.192	t值		2.723	2.779
P值		0.683	0.848	P值		0.008	0.006

临床病理特征	例数	PDK1/（ng·mL^-1）	SFRP4/（ng·mL^-1）	临床病理特征	例数	PDK1/（ng·mL^-1）	SFRP4/（ng·mL^-1）
年龄				TNM分期
<60岁	48	5.63±1.78	40.56±12.42	Ⅰ~Ⅱ期	58	5.48±1.44	43.17±13.57
≥60岁	56	6.11±1.63	38.87±12.44	Ⅲ期	46	6.41±2.03	35.21±10.99
t值		1.435	0.691	t值		2.730	3.225
P值		0.154	0.491	P值		0.007	0.002
性别				分化程度
男	62	5.98±1.73	38.26±12.24	中/高分化	63	5.52±1.50	42.83±13.59
女	42	5.76±1.66	41.70±12.71	低分化	41	6.46±2.01	34.76±10.65
t值		0.647	1.385	t值		2.727	3.212
P值		0.519	0.169	P值		0.008	0.002
组织学类型				淋巴转移
腺癌	88	5.86±1.74	39.75±12.39	无	51	5.42±1.42	43.11±13.24
鳞癌	16	6.05±1.48	39.10±12.65	有	53	6.34±1.97	36.32±11.65
t值		0.410	0.192	t值		2.723	2.779
P值		0.683	0.848	P值		0.008	0.006

组别	例数	PDK1/（ng·mL^-1）	SFRP4/（ng·mL^-1）
生存组	58	4.82±1.35	47.94±13.23
死亡组	46	7.24±2.14	29.20±11.42
t值		7.031	7.615
P值		<0.001	<0.001