粪便SDC2和TFPI2基因甲基化联合检测对结直肠癌及癌前病变的诊断效能分析

Analysis on diagnostic efficacy of combined detection of fecal genes SDC2 and TFPI2 methylation in diagnosing colorectal cancer and precancerous lesions

目的 探究粪便硫酸类肝素蛋白多糖(Syndecan 2,SDC2)和组织因子途径抑制物2(Tissue factor pathway inhibitor 2, TFPI2)基因甲基化联合检测对结直肠癌及癌前病变的诊断效能。方法 纳入2020年5月~2021年4月于我院消化内科门诊及住院就诊的45例结直肠病变患者作为研究对象,另纳入同期于我院行体格检查的健康者21例作为对照组,经结直肠镜和术后病理学检查,45例结直肠病变患者中确诊结直肠癌25例,结直肠腺瘤20例。采用甲基化特异性PCR(Methylation-specific PCR,MSP)法检测各组受试者中SDC2和TFPI2基因甲基化情况。应用受试者工作特征(Receiver operating characteristic,ROC)曲线判定SDC2和TFPI2基因甲基化单项检测和联合检测对结直肠癌及癌前病变的诊断效能。结果 结直肠癌组和结直肠腺瘤组SDC2和TFPI2基因甲基化阳性水平均显著高于对照组(P<0.05)。SDC2和TFPI2基因甲基化对结直肠癌诊断的ROC曲线下面积分别为0.744[95%CI(0.624~0.863)]和0.751[95%CI(0.631~0.879)],敏感度分别为71.61%和73.71%,特异性分别为73.21%和71.06%,两者联合检测对结直肠癌诊断的曲线下面积为0.913[95%CI(0.869~0.956)],敏感度为81.37%,特异性为78.66%;SDC2和TFPI2基因甲基化诊断结直肠腺瘤的ROC曲线下面积分别为0.713[95%CI(0.592~0.831)]和0.721[95%CI(0.598~0.847)],敏感度分别为66.31%和59.89%,特异性分别为67.75%和70.40%,两者联合检测诊断结直肠腺瘤的曲线下面积为0.878[95%CI(0.833~0.921)],敏感度为73.38%,特异性为81.34%。结论 粪便SDC2和TFPI2基因甲基化检测可作为临床诊断结直肠癌和结直肠腺瘤的重要生物学指标,且两者联合检测的诊断效能更高,可为临床早期筛查结直肠癌和癌前病变、及早干预、改善预后提供一定的帮助。

Objective To investigate the diagnostic efficacy of combined detection of fecal genes syndecan 2(SDC2) and tissue factor pathway inhibitor 2(TFPI2) methylation in diagnosing colorectal cancer and precancerous lesions. Methods 45 cases of colorectal lesions patients admitted to our hospital from May 2020 to Apr 2021were collected as research group, another 21 healthy subjects were collected as control group, the research group was divided into colorectal cancer group(25 cases) and colorectal adenoma group(20 cases) according to colorectal endoscopic and postoperative pathological examination. Methylation-specific PCR(MSP) was conducted to detect the SDC2 and TFPI2 methylation, the diagnostic efficacy was evaluated by receiver operating characteristic curve(ROC).Results The methylation of SDC2 and TFPI2 genes of colorectal cancer group and colorectal adenoma group were all higher than control group(P<0.05). The AUC of SDC2 and TFPI2 genes methylation in diagnosing colorectal cancer was 0.744[95%CI(0.624~0.863)] and 0.751[95%CI(0.631~0.879)], sensitivity was 71.61% and 73.71%, specificity was 73.21% and 71.06% respectively, the AUC, sensitivity and specificity of SDC2+TFPI2 genes methylation was 0.913[95%CI(0.869~0.956)], 81.37% and 78.66%. The AUC of SDC2 and TFPI2 genes methylation in diagnosing colorectal adenoma was 0.713[95%CI(0.592~0.831)] and 0.721[95%CI(0.598~0.847)], sensitivity was 66.31%and 59.89%, specificity was 67.75% and 70.40%, the AUC, sensitivity and specificity of SDC2+TFPI2 genes methylation was 0.878[95%CI(0.833~0.921)], 73.38% and 81.34%. Conclusion Fecal genes SDC2 and TFPI2methylation could be used as important biological indicators in diagnosing colorectal cancer and colorectal adenoma. Combining detection has higher diagnostic efficacy, which could be value for early screening, early intervention and improvement.