血清同型半胱氨酸水平与直肠癌发生和分期的相关性研究

发布时间：2018-02-27 16:37

本文关键词： 同型半胱氨酸肿瘤标志物结直肠癌　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景直肠癌是我国高发的消化道恶性肿瘤。2017年NCCN指南显示,美国结直肠癌的发病率居其所有恶性肿瘤的第4位,但死亡率却呈现明显的下降趋势,分析其原因可能得益于美国注重早期筛查、早期诊断的完善实施,以及更加优良的治疗手段的进步。目前,我国医疗的早期筛查和早期诊断尚存在一定的欠缺,提高疾病筛查的有效性迫在眉睫。临床上常用的结直肠癌及癌前病变主要筛选方法包括:基于高风险因素的问卷调查,直肠指检,粪便潜血试验,电子结肠镜检查和病理检查。这些检查方法用于结直肠癌的早期筛查、早期诊断都具有一定的局限性。近年来随着研究的不断更新,同型半胱氨酸(Homocysteine,Hcy)作为一种全新的肿瘤危险因素得到广泛的关注。文献报道Hcy在消化、呼吸、生殖、内分泌系统的恶性肿瘤中具有一定的诊断价值。将血清Hcy作为血清肿瘤标志物用于恶性肿瘤的早期诊断、治疗、预后判断、病情复发的监测可能具有广阔的应用前景。但有关Hcy与直肠癌的相关性研究未见报道,因此,本课题以Hcy做为研究指标,初步探讨Hcy与直肠癌发生发展的相关性,为Hcy作为直肠癌早期筛查与诊断的潜在指标提供初步的理论依据。研究目的通过比较正常人群,直肠息肉患者与直肠癌患者的血清Hcy水平,以及不同病理分期直肠癌患者的血清Hcy水平,探讨检测血清Hcy水平对直肠病变早期筛查和早期诊断的价值,研究Hcy与直肠癌病理分期的相关性。研究方法随机选取2015年5月-2017年2月期间于山东大学齐鲁医院入住消化内科、普外科、肿瘤科等三个科室的住院患者共计233例,其中直肠息肉患者共计101例,直肠癌患者共计132例,另随机选取正常人群80例,病例共计313例。根据电子纤维肠镜及病理分析结果,将研究对象分为正常人群组、直肠息肉患者组、直肠癌患者组。另外,参照息肉切除术术后病理结果,根据高危腺瘤定义,将直肠息肉患者分为两个亚组:低危组(n=84)和高危组(n=17)。参照恶性肿瘤患者的手术记录、术后病理分析结果及术前相关影像学检查的结果,根据美国癌症联合会(AJCC)第7版分期标准将直肠癌患者分为4个亚组:Ⅰ期组(n=28)、Ⅱ期组(n=38)、Ⅲ期组(n=48)和ⅣV期组(n=18)。比较各组Hcy及其他肿瘤标志物指标的差异并分析其与直肠癌的发生及直肠癌不同病理分期的相关性。对血清Hcy水平的检测采用单循环酶法。所有检测数据采用SPSS 18.0软件进行统计分析。结果1.血清中Hcy水平在正常人群、直肠息肉低危组、直肠息肉高危组以及各期直肠癌之间逐渐升高,且组间有显著差异(p=0.006、0.017、0.001、0.001、0.001、0.001);在7个亚组中,直肠息肉低危组与直肠息肉高危组、Ⅰ期直肠癌组无统计学差异(p=0.459、0.102),直肠息肉低危组与Ⅱ期-Ⅳ期直肠癌组存在显著差异(p=0.001、0.001、0.001);直肠息肉高危组与Ⅰ期直肠癌无明显统计学差异(p=0.592),与Ⅱ期-Ⅳ期直肠癌存在显著差异(p=0.018、0.001、0.001);Ⅰ期直肠癌与Ⅱ期-Ⅳ期直肠癌存在显著差异(p=0.035、0.001、0.001);Ⅱ期直肠癌与Ⅳ期直肠癌存在显著差异(p=0.017)。2.Hcy与直肠病变进展具有显著的相关性,其相关系数为0.490,p0.001。Hcy与直肠癌的分期存在显著的相关性,其相关系数为0.186,p=0.006。Hcy与直肠息肉低危组以及高危组之间无明显的相关性,其相关系数为0.094,p=0.386。Hcy在是否患直肠癌的相关性上是显著的,相关系数是0.487,p0.001。3.Logistic回归分析显示,经校正年龄、性别、肿瘤标志物等其他危险因素后,其 OR(95%CI)= 1.186(1.051-1.338),p=0.006,血清 Hcy 水平依然与直肠癌的发生显著相关,且优于其他肿瘤标志物。结论1.血清中Hcy水平随着直肠病变进展逐渐升高。2.血清中Hcy水平是直肠癌的相关因素,且独立于年龄、性别和其他肿瘤标志物;3.血清中Hcy水平具有应用于直肠癌早期筛查诊断和检测的潜在可能性。
[Abstract]:The research background of rectal cancer with high incidence in China is a malignant tumor of digestive tract.2017 NCCN guidelines, the incidence rate of colorectal cancer in the United States fourth of all malignant tumors, but the mortality rate is decreased obviously, analysis of the reasons may be due to the United States focus on early screening, early diagnosis and improve the implementation and progress, more excellent treatment. At present, the early screening and early diagnosis of medical treatment in our country there are still some deficiencies, improve the effectiveness of screening for the disease is imminent. Including clinical colorectal cancer and cancer lesions commonly used before the main screening methods: questionnaire survey of high risk factors based on digital rectal examination, fecal occult blood test, colonoscopy and pathological examination. The examination method for early colorectal cancer screening, early diagnosis has some limitations. In recent years, with the development of the research of new type. Cysteine (Homocysteine, Hcy) as a new tumor risk factors have received extensive attention. Reported that Hcy in the digestive, respiratory, reproductive, endocrine system has some value in the diagnosis of malignant tumors. The serum Hcy as a serum tumor marker for early diagnosis of malignant tumor, treatment, prognosis, monitoring relapse may have broad application prospects. But the correlation between Hcy and colorectal cancer has not been reported. Therefore, this paper takes Hcy as the research target, preliminary study on relationship between Hcy and the occurrence and development of colorectal cancer, and provide the theoretical basis for the Hcy as a potential marker for early screening and diagnosis of colorectal cancer. The purpose of the study is to compare the normal population the level of serum Hcy in patients with colorectal polyps, and colorectal cancer patients, and different pathological stages of colorectal cancer patients serum Hcy level, serum Hcy level detection The rectal lesions early screening and early diagnosis, correlation between Hcy and pathologic staging of rectal cancer. Methods randomly selected from May 2015 -2017 year in February in Qilu Hospital of Shandong University in the Department of Gastroenterology, Department of general surgery, Department of oncology and other three departments of the inpatients were 233 cases, including rectal polyps in patients with a total of 101 cases, a total of 132 patients with rectal cancer another example, randomly selected 80 normal subjects, 313 cases of electronic colonoscopy and pathology. According to the analysis results, the subjects were divided into normal group, group of patients with rectal polyps, patients of rectal cancer. In addition, according to polyp resection pathology results, according to the definition of high-risk adenoma, patients with rectal polyps were divided into two sub groups: low risk group (n=84) and high risk group (n=17). According to the surgical records of patients with malignant tumors, and the analysis result of preoperative imaging examination results of pathology after operation , according to the American Cancer Association (AJCC) seventh edition staging rectal cancer patients were divided into 4 groups: group I (n=28), group II (n=38), group III and IV (n=48) V group (n=18). Compare the differences in groups Hcy and other tumor markers and the analysis and the occurrence of colorectal cancer and colorectal cancer in different pathological stages. The correlation detection of the serum Hcy level by cyclophorase method. All test data were statistically analyzed by SPSS 18 software. Results 1. serum levels of Hcy in the normal population, rectal polyps in low risk group, high risk group and the rectal polyps between rectal cancer gradually increased, and there were significantly different between groups (p=0.006,0.017,0.001,0.001,0.001,0.001); in the 7 subgroups, rectal polyps in low risk group and high risk group of rectal polyps, there was no significant difference in stage I rectal cancer group (p=0.459,0.102), rectal polyps in low risk group and II - IV colorectal cancer group deposit There were significant differences (p=0.001,0.001,0.001); rectal polyps in high-risk group with primary rectal cancer had no significant difference (p=0.592), there was significant difference with II - IV colorectal cancer (p=0.018,0.001,0.001); there were significant differences in phase I and II - IV colorectal rectal cancer (P =0.035,0.001,0.001); there were significant differences in stage II rectal cancer with stage IV colorectal cancer (p=0.017) in.2.Hcy and rectal lesions had significant correlation, the correlation coefficient is 0.490, and the p0.001.Hcy staging of rectal cancer has significant correlation, the correlation coefficient is 0.186, there is no obvious correlation between p= and 0.006.Hcy rectal polyps in low risk group and high risk group, the correlation coefficient is 0.094, p=0.386.Hcy is significant in whether the correlation between rectal cancer is 0.487, correlation coefficient, p0.001.3.Logistic regression analysis showed that after adjusting for age, gender, tumor markers and other risk factors After the OR (95%CI) = 1.186 (1.051-1.338), p=0.006, serum Hcy level is still significantly associated with the occurrence of colorectal cancer, and is superior to other tumor markers. Conclusion the level of Hcy 1. in serum with rectal lesions progress gradually increased the level of Hcy.2. in serum of colorectal cancer is related factors, and independent of age and gender. Other potential tumor markers; Hcy 3. level in serum is applied to colorectal cancer screening and early diagnosis test.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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