D-二聚體聯(lián)合腫瘤標志物檢測在結(jié)直腸癌中的臨床意義
發(fā)布時間：2019-03-27 21:02
【摘要】：目的:探討血漿D-二聚體和血清癌胚抗原(CEA)、糖鏈抗原19-9(CA19-9)及癌抗原(CA72-4)在結(jié)直腸癌中的表達情況及診斷價值,觀察結(jié)直腸癌患者是否存在凝血及纖溶系統(tǒng)異常。方法:選取2013年6月至2015年1月在我院住院的結(jié)直腸癌患者76例,選取同期住院的非腫瘤患者60例作為對照,采用免疫比濁法及化學(xué)發(fā)光法測定2組患者住院后未治療前的血漿D-二聚體及血清CEA、CA19-9、CA72-4的水平。收集患者相關(guān)數(shù)據(jù)資料,應(yīng)用SPASS22.0軟件進行統(tǒng)計學(xué)分析。結(jié)果:1.76例結(jié)直腸癌患者中,38例D-二聚體升高,陽性率為50.0%;三種腫瘤標志物CEA、CA19-9、CA72-4升高的例數(shù)分別是26例、17例、25例,陽性率分別是34.2%、22.4%、32.9%。D-二聚體陽性率高于CEA、CA19-9、CA72-4(P0.05)。2.結(jié)直腸癌組、對照組患者D-二聚體及3種腫瘤標志物的比較:結(jié)直腸癌組D-二聚體及CEA、CA19-9、CA72-4的水平分別高于非腫瘤對照組,差異有統(tǒng)計學(xué)意義(P0.001)。3.D-二聚體及3種腫瘤標志物與結(jié)直腸癌患者臨床、病理因素的關(guān)系:D-二聚體及3種腫瘤標志物在結(jié)直腸癌III+IV期的水平均高于I+II期,差異有統(tǒng)計學(xué)意義(P0.05);有淋巴結(jié)轉(zhuǎn)移或遠處轉(zhuǎn)移組比無淋巴結(jié)轉(zhuǎn)移或無遠處轉(zhuǎn)移組水平高(P0.05);4者的表達在不同年齡、性別分組中無明顯差異(P0.05)。4.D-二聚體水平與3種腫瘤標志物的相關(guān)性:結(jié)直腸癌患者的D-二聚體水平分別與CEA、CA19-9、CA72-4正相關(guān)。5.D-二聚體及3種腫瘤標志物在診斷結(jié)直腸癌中的價值:D-二聚體在診斷結(jié)直腸癌時的ROC曲線下面積是0.812,而CEA、CA19-9及CA72-4的ROC曲線下面積分別為0.748、0.704、0.672。6.D-二聚體及3種腫瘤標志物在結(jié)直腸癌的敏感度和特異度:D-二聚體在單項檢測時敏感度最高,其次是CEA、CA72-4、CA19-9,但在4種標記物中,D-二聚體特異性最低;當三聯(lián)或四聯(lián)檢測時,敏感度雖仍較低,但較單項檢測時逐漸提高。結(jié)論:1.D-二聚體及CEA、CA19-9、CA72-4在結(jié)直腸癌患者中高表達,結(jié)直腸癌患者存在高凝狀態(tài)。2.D-二聚體及CEA、CA19-9、CA72-4可能與結(jié)直腸癌TNM分期、淋巴結(jié)或遠處轉(zhuǎn)移狀態(tài)、淋巴結(jié)轉(zhuǎn)移個數(shù)有關(guān),可能與年齡、性別無關(guān),分期越晚、有淋巴結(jié)轉(zhuǎn)移或遠處轉(zhuǎn)移、淋巴結(jié)轉(zhuǎn)移個數(shù)越多,D-二聚體及CEA、CA19-9、CA72-4水平越高。3.結(jié)直腸癌患者D-二聚體水平分別與CEA、CA19-9、CA72-4正相關(guān)。4.動態(tài)監(jiān)測D-二聚體及CEA、CA19-9、CA72-4水平,有助于了解結(jié)直腸癌患者病情進展情況。5.D-二聚體及CEA、CA19-9、CA72-4雖然不能確診結(jié)直腸癌,但是可作為重要的輔助診斷方法之一,D-二聚體及CEA、CA19-9、CA72-4聯(lián)合檢測,可提高靈敏度。6.惡性腫瘤易合并高凝狀態(tài),動態(tài)監(jiān)測D-二聚體水平,了解患者機體的凝血及纖溶狀態(tài),并及早干預(yù),可減少血栓性并發(fā)癥的發(fā)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.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.34
本文編號：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.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.34
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