D-二聚体联合肿瘤标志物检测在结直肠癌中的临床意义
发布时间：2019-03-27 21:02
【摘要】：目的:探讨血浆D-二聚体和血清癌胚抗原(CEA)、糖链抗原19-9(CA19-9)及癌抗原(CA72-4)在结直肠癌中的表达情况及诊断价值,观察结直肠癌患者是否存在凝血及纤溶系统异常。方法:选取2013年6月至2015年1月在我院住院的结直肠癌患者76例,选取同期住院的非肿瘤患者60例作为对照,采用免疫比浊法及化学发光法测定2组患者住院后未治疗前的血浆D-二聚体及血清CEA、CA19-9、CA72-4的水平。收集患者相关数据资料,应用SPASS22.0软件进行统计学分析。结果:1.76例结直肠癌患者中,38例D-二聚体升高,阳性率为50.0%;三种肿瘤标志物CEA、CA19-9、CA72-4升高的例数分别是26例、17例、25例,阳性率分别是34.2%、22.4%、32.9%。D-二聚体阳性率高于CEA、CA19-9、CA72-4(P0.05)。2.结直肠癌组、对照组患者D-二聚体及3种肿瘤标志物的比较:结直肠癌组D-二聚体及CEA、CA19-9、CA72-4的水平分别高于非肿瘤对照组,差异有统计学意义(P0.001)。3.D-二聚体及3种肿瘤标志物与结直肠癌患者临床、病理因素的关系:D-二聚体及3种肿瘤标志物在结直肠癌III+IV期的水平均高于I+II期,差异有统计学意义(P0.05);有淋巴结转移或远处转移组比无淋巴结转移或无远处转移组水平高(P0.05);4者的表达在不同年龄、性别分组中无明显差异(P0.05)。4.D-二聚体水平与3种肿瘤标志物的相关性:结直肠癌患者的D-二聚体水平分别与CEA、CA19-9、CA72-4正相关。5.D-二聚体及3种肿瘤标志物在诊断结直肠癌中的价值:D-二聚体在诊断结直肠癌时的ROC曲线下面积是0.812,而CEA、CA19-9及CA72-4的ROC曲线下面积分别为0.748、0.704、0.672。6.D-二聚体及3种肿瘤标志物在结直肠癌的敏感度和特异度:D-二聚体在单项检测时敏感度最高,其次是CEA、CA72-4、CA19-9,但在4种标记物中,D-二聚体特异性最低;当三联或四联检测时,敏感度虽仍较低,但较单项检测时逐渐提高。结论:1.D-二聚体及CEA、CA19-9、CA72-4在结直肠癌患者中高表达,结直肠癌患者存在高凝状态。2.D-二聚体及CEA、CA19-9、CA72-4可能与结直肠癌TNM分期、淋巴结或远处转移状态、淋巴结转移个数有关,可能与年龄、性别无关,分期越晚、有淋巴结转移或远处转移、淋巴结转移个数越多,D-二聚体及CEA、CA19-9、CA72-4水平越高。3.结直肠癌患者D-二聚体水平分别与CEA、CA19-9、CA72-4正相关。4.动态监测D-二聚体及CEA、CA19-9、CA72-4水平,有助于了解结直肠癌患者病情进展情况。5.D-二聚体及CEA、CA19-9、CA72-4虽然不能确诊结直肠癌,但是可作为重要的辅助诊断方法之一,D-二聚体及CEA、CA19-9、CA72-4联合检测,可提高灵敏度。6.恶性肿瘤易合并高凝状态,动态监测D-二聚体水平,了解患者机体的凝血及纤溶状态,并及早干预,可减少血栓性并发症的发生。
[Abstract]:Objective: to investigate the expression and diagnostic value of plasma D-dimer and serum carcinoembryonic antigen (CEA), glycan antigen 19 / 9 (CA19-9) and carcinoantigen (CA72-4) in colorectal cancer. To observe the presence of coagulation and fibrinolytic system abnormalities in patients with colorectal cancer. Methods: 76 cases of colorectal cancer hospitalized in our hospital from June 2013 to January 2015 were selected and 60 cases of non-tumor patients in the same period were selected as control. The levels of plasma D-dimer and serum CEA,CA19-9,CA72-4 were measured by immunoturbidimetry and chemiluminescence. The data of patients were collected and analyzed by SPASS22.0 software. Results: in 1.76 cases of colorectal cancer, 38 cases had increased D-dimer, the positive rate was 50.0%. The positive rates of CEA,CA19-9,CA72-4 were 34.2%, 22.4% and 32.9%, respectively. The positive rate of D-dimer was higher than that of CEA,CA19-9,. CA72-4 (P0.05) .2. Comparison of D-dimer and three tumor markers in colorectal cancer group and control group: the levels of D-dimer and CEA,CA19-9,CA72-4 in colorectal cancer group were higher than those in non-tumor control group. The difference was statistically significant (P0.001). 3.D-dimer and three tumor markers were associated with the clinical features of colorectal cancer patients. The relationship between pathological factors: the levels of D-dimer and three tumor markers in III IV stage of colorectal cancer were higher than those in III stage, the difference was statistically significant (P0.05). The level of lymph node metastasis or distant metastasis group was higher than that of no lymph node metastasis or distant metastasis group (P0.05). The expression of D-dimer was not significantly different in different age and sex groups (P0.05). 4. The correlation between D-dimer level and three tumor markers: the level of D-dimer in colorectal cancer patients was related to CEA,CA19-9, respectively. 5. The value of D-dimer and three tumor markers in the diagnosis of colorectal cancer: the area under the ROC curve of D-dimer in the diagnosis of colorectal cancer was 0.812, while that of CEA, was 0.812. The area under ROC curve of CA19-9 and CA72-4 were 0.748, 0.704,0.672.6.D-dimer and the sensitivity and specificity of three tumor markers in colorectal cancer, respectively. The sensitivity of D-dimer was the highest in single detection, followed by CEA,. The specificity of D-dimer was the lowest among the four markers of CA72-4,CA19-9,. When triple or quad detection, although the sensitivity is still low, but gradually improved compared with the single test. Conclusions: 1. High expression of D-dimer and CEA,CA19-9,CA72-4 in colorectal cancer patients and hypercoagulability in colorectal cancer patients. 2. D-dimer and CEA,CA19-9,CA72-4 may be associated with TNM stage of colorectal cancer. 2. Lymph node or distant metastasis status, number of lymph node metastasis, may not be related to age, sex, the later staging, there is lymph node metastasis or distant metastasis, the more lymph node metastasis, D-dimer and CEA,CA19-9, The higher the level of CA72-4. 3. The level of D-dimer in colorectal cancer patients was positively correlated with CEA,CA19-9,CA72-4. 4. Dynamic monitoring of D-dimer and CEA,CA19-9,CA72-4 levels can help to understand the progression of colorectal cancer. 5. Although D-dimer and CEA,CA19-9,CA72-4 can not be diagnosed with colorectal cancer, But as one of the important auxiliary diagnostic methods, the combined detection of D-dimer and CEA,CA19-9,CA72-4 can improve the sensitivity. 6. Malignant tumors are prone to hypercoagulability, dynamic monitoring of D-dimer level, understanding of the coagulation and fibrinolysis status of patients, and early intervention, can reduce the occurrence of thrombotic complications.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.34
本文编号：2448559
[Abstract]:Objective: to investigate the expression and diagnostic value of plasma D-dimer and serum carcinoembryonic antigen (CEA), glycan antigen 19 / 9 (CA19-9) and carcinoantigen (CA72-4) in colorectal cancer. To observe the presence of coagulation and fibrinolytic system abnormalities in patients with colorectal cancer. Methods: 76 cases of colorectal cancer hospitalized in our hospital from June 2013 to January 2015 were selected and 60 cases of non-tumor patients in the same period were selected as control. The levels of plasma D-dimer and serum CEA,CA19-9,CA72-4 were measured by immunoturbidimetry and chemiluminescence. The data of patients were collected and analyzed by SPASS22.0 software. Results: in 1.76 cases of colorectal cancer, 38 cases had increased D-dimer, the positive rate was 50.0%. The positive rates of CEA,CA19-9,CA72-4 were 34.2%, 22.4% and 32.9%, respectively. The positive rate of D-dimer was higher than that of CEA,CA19-9,. CA72-4 (P0.05) .2. Comparison of D-dimer and three tumor markers in colorectal cancer group and control group: the levels of D-dimer and CEA,CA19-9,CA72-4 in colorectal cancer group were higher than those in non-tumor control group. The difference was statistically significant (P0.001). 3.D-dimer and three tumor markers were associated with the clinical features of colorectal cancer patients. The relationship between pathological factors: the levels of D-dimer and three tumor markers in III IV stage of colorectal cancer were higher than those in III stage, the difference was statistically significant (P0.05). The level of lymph node metastasis or distant metastasis group was higher than that of no lymph node metastasis or distant metastasis group (P0.05). The expression of D-dimer was not significantly different in different age and sex groups (P0.05). 4. The correlation between D-dimer level and three tumor markers: the level of D-dimer in colorectal cancer patients was related to CEA,CA19-9, respectively. 5. The value of D-dimer and three tumor markers in the diagnosis of colorectal cancer: the area under the ROC curve of D-dimer in the diagnosis of colorectal cancer was 0.812, while that of CEA, was 0.812. The area under ROC curve of CA19-9 and CA72-4 were 0.748, 0.704,0.672.6.D-dimer and the sensitivity and specificity of three tumor markers in colorectal cancer, respectively. The sensitivity of D-dimer was the highest in single detection, followed by CEA,. The specificity of D-dimer was the lowest among the four markers of CA72-4,CA19-9,. When triple or quad detection, although the sensitivity is still low, but gradually improved compared with the single test. Conclusions: 1. High expression of D-dimer and CEA,CA19-9,CA72-4 in colorectal cancer patients and hypercoagulability in colorectal cancer patients. 2. D-dimer and CEA,CA19-9,CA72-4 may be associated with TNM stage of colorectal cancer. 2. Lymph node or distant metastasis status, number of lymph node metastasis, may not be related to age, sex, the later staging, there is lymph node metastasis or distant metastasis, the more lymph node metastasis, D-dimer and CEA,CA19-9, The higher the level of CA72-4. 3. The level of D-dimer in colorectal cancer patients was positively correlated with CEA,CA19-9,CA72-4. 4. Dynamic monitoring of D-dimer and CEA,CA19-9,CA72-4 levels can help to understand the progression of colorectal cancer. 5. Although D-dimer and CEA,CA19-9,CA72-4 can not be diagnosed with colorectal cancer, But as one of the important auxiliary diagnostic methods, the combined detection of D-dimer and CEA,CA19-9,CA72-4 can improve the sensitivity. 6. Malignant tumors are prone to hypercoagulability, dynamic monitoring of D-dimer level, understanding of the coagulation and fibrinolysis status of patients, and early intervention, can reduce the occurrence of thrombotic complications.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.34
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