联合检测凝血4项和肿瘤标志物在结直肠癌中的临床意义和诊断价值
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摘要
目的:探讨联合检测凝血4项和肿瘤标志物在结直肠癌中的临床意义和诊断价值。方法:检测84例结直肠癌患者和80例结直肠良性疾病患者外周血中纤维蛋白原(FIB)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)水平;应用ROC曲线分析各指标的诊断价值。结果:结直肠癌患者术前FIB、CA19-9、CEA水平均明显高于结直肠良性疾病患者,差异有统计学意义(P <0. 05);Ⅲ-Ⅳ期结直肠癌患者FIB、CA19-9、CEA水平均明显高于Ⅰ-Ⅱ期患者,差异有统计学意义(P <0. 05);结直肠癌患者FIB水平和CEA、CA19-9水平存在着相关性。联合检测FIB、CA19-9、CEA水平可提高结直肠癌的诊断率。结论:术前肿瘤标志物及凝血4项的检测有助于鉴别结直肠良性、恶性肿瘤及监测血栓的形成,提高诊断效能,有利于早期发现与治疗。
Objective: To explore the diagnostic value and clinical significance of tumor marker and blood coagulation in colorectal cancer. Methods: The peripheral fibrinogen( FIB),CA19-9,CEA were detected in 84 colorectal cancer patients and in 80 non-tumor patients. Using Logistic regression and ROC curve analysis to assess the diagnostic value of various indicators. Results: The levels of FIB,CA19-9,CEA in colorectal cancer patients before surgery were significantly higher than those in non-tumor patients,and the differences were statistically significant( P <0. 05). Compared with colorectal cancer Ⅰ-Ⅱ,FIB,CA19-9,CEA levels were significantly higher in Ⅲ-Ⅳ patients,and the differences were statistically significant( P < 0. 05). The level of FIB was consilient correlated with CEA,CA19-9 in colorectal cancer patients,Youden's index and the area under ROC curve( AUC) in colorectal cancer diagnosis were improved by combined detection of FIB,CA19-9,CEA. Conclusion: The detection of FIB,CA19-9,CEA before surgery can help to distinguish benign colorectal cancer and malignant colorectal diseases,and monitor thrombus formation,raise the diagnostic value and contribute to early diagnosis and treatment.
Objective: To explore the diagnostic value and clinical significance of tumor marker and blood coagulation in colorectal cancer. Methods: The peripheral fibrinogen( FIB),CA19-9,CEA were detected in 84 colorectal cancer patients and in 80 non-tumor patients. Using Logistic regression and ROC curve analysis to assess the diagnostic value of various indicators. Results: The levels of FIB,CA19-9,CEA in colorectal cancer patients before surgery were significantly higher than those in non-tumor patients,and the differences were statistically significant( P <0. 05). Compared with colorectal cancer Ⅰ-Ⅱ,FIB,CA19-9,CEA levels were significantly higher in Ⅲ-Ⅳ patients,and the differences were statistically significant( P < 0. 05). The level of FIB was consilient correlated with CEA,CA19-9 in colorectal cancer patients,Youden's index and the area under ROC curve( AUC) in colorectal cancer diagnosis were improved by combined detection of FIB,CA19-9,CEA. Conclusion: The detection of FIB,CA19-9,CEA before surgery can help to distinguish benign colorectal cancer and malignant colorectal diseases,and monitor thrombus formation,raise the diagnostic value and contribute to early diagnosis and treatment.
引文
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[16]Zhang ZY,He JH.An analysis of the correlation of fibrinogen to the prognosis for patients of colorectal cancer[J].Health Research,2014,34(03):272-273.[张志勇,何炬辉.纤维蛋白原与结直肠癌患者预后的多因素分析[J].健康研究,2014,34(03):272-273.]
[2]Long JN,Hu L,Rao JH,et al.Low-dose aspirin prevents the occurrence and development of colorectal cancer:new ideas and new evidence[J].Practical Journal of Medicine,2017,33(18):2979-2982.[龙洁旎,胡露,饶甲环,等.低剂量阿司匹林预防结直肠癌发生发展的新观点及新证据[J].实用医学杂志,2017,33(18):2979-2982.]
[3]Xiong YJ,Luo HS.Changes and significance of the five coagulation in patients with colorectal cancer[J].Chin J Gastroenterol Hepatol,2017,26(02):151-153.[熊燕鹃,罗和生.凝血5项在结直肠癌患者中的变化及意义[J].胃肠病学和肝病学杂志,2017,26(02):151-153.]
[4]Khorana AA.Venous thromboembolism and prognosis in cancer[J].Thromb Res,2010,125(6):490-493.
[5]Khosa F,Otero HJ,Prevedello LM,et al.Imaging presentation of venous thrombosis in patients with cancer[J].AJR Am J Roentgenol,2010,194(4):1099-1108.
[6]Ye WD,Zou LF,Yao YY,et al.The study of heamostatic function in patients with gastrointestinal cancer[J].Chinese Journal of Thrombosis and Hemostasis,2015,21(04):222-224.[叶为德,邹丽芳,姚一芸,等.胃肠道恶性肿瘤患者凝血功能的研究[J].血栓与止血学,2015,21(04):222-224.]
[7]Wu YY.Diagnostic value of CA125,HE4 combined with D-dimer and platelets in ovarian malignant tumors[J].Mod Diagn Treat,2016,17:3259-3261.[吴蕴瑜.CA125、HE4联合D-二聚体、血小板在卵巢恶性肿瘤的诊断价值[J].现代诊断与治疗,2016,17:3259-3261.]
[8]Tiedje V,Dunkler D,Ay C,et al.The role of fibrinogen plasma levels,the-455G>A fibrinogen and the factor XIII A subunit(FXI-II-A)Val34Leu polymorphism in cancer-associated venous thrombosis[J].Thromb Haemost,2011,106(5):908-913.
[9]Zhang Y,Zhang YP.The clinical significance of coagulation test in patients with bladder cancer[J].Zhejiang Clinical Medicine,2014,4:619-620.[张延,张翼鹏.膀胱癌患者凝血功能检测的临床意义[J].浙江临床医学,2014,4:619-620.]
[10]Palumbo JS,Talmage KE,Massari JV,et al.Platelets and fibrin(ogen)increase metastatic potential by impeding natural killer cell-mediated elimination of tumor cells[J].Blood,2005,105(1):178-185.
[11]Huang M,Huang ZH,Yan XY,et al.Clinical significance of detection of plasma fibrinogen and angiopoietin-2 in patients with colorectal carcinoma[J].Pract Prev Med,2017,24(05):623-625.[黄敏,黄志红,闫晓煜,等.结直肠癌患者血浆FIB和ANG-2检测的临床意义[J].实用预防医学,2017,24(05):623-625.]
[12]Huang WJ,Zheng ZM,Lin SX,et al.Application of combined determination of CEA and CA724 in the diagnosis of colorectal cancer[J].Pract Prev Med,2011,27(12):2252-2254.[黄妩姣,郑智明,林素香,等.CEA和CA724联合检测在结直肠癌诊断中的应用[J].实用医学杂志,2011,27(12):2252-2254.]
[13]Duffy MJ.Carcinoembryonic antigen as a marker for colorectal cancer:is it clinically useful[J]?Clin Chem,2001,47(4):624-630.
[14]Li YH.Clinical significance of D-dimer combined tumor maker examination in colorectal cancer[D].Yan'an University,2015:1-47.[李玉华.D-二聚体联合肿瘤标志物检测在结直肠癌中的临床意义[D].延安大学,2015:1-47.]
[15]Wang JW,Han T,Chen X,et al.The correlation study of betafbrinogen gene polymorphisms and plasma fbrinogen concentration in patients with colorectal cancer[J].China Oncology,2015,25(10):807-811.[王静文,韩韬,陈玺,等.结直肠癌患者β-纤维蛋白原基因多态性和血浆纤维蛋白原水平相关性的研究[J].中国癌症杂志,2015,25(10):807-811.]
[16]Zhang ZY,He JH.An analysis of the correlation of fibrinogen to the prognosis for patients of colorectal cancer[J].Health Research,2014,34(03):272-273.[张志勇,何炬辉.纤维蛋白原与结直肠癌患者预后的多因素分析[J].健康研究,2014,34(03):272-273.]