结直肠癌患者血清D-dimer与C-反应蛋白的检测及其临床意义

Detection of serum D-dimer and CRP in patients with colorectal cancer and its clinical significance

目的评估结直肠癌(colorectal carcinoma,CRC)患者血清D-dimer与C-反应蛋白(C-reactive protein,CRP)检测的临床意义。方法收集53例CRC患者与30例健康者对照,患者术前及术后1、3、7 d采集血样,对照在体检时采集的血样;检测血清D-dimer与CRP并对淋巴结转移、血管浸润和TNM分级不同病理参数间检测值进行对比分析;对开腹手术和腹腔镜手术术后检测值进行对比分析;对患者术前CRP与D-dimer检测值进行相关性分析。结果 CRC患者D-dimer、CRP显著高于健康人群(P<0.01);淋巴结转移和血管浸润阳性患者D-dimer[(2.33±0.72)mg/L]与CRP[(16.0±1.5)mg/L]水平高于阴性患者(P<0.01);TNM分级各级患者间D-dimer与CRP水平有统计学差异,随病理等级增加而升高(P<0.01)。D-dimer和CRP在术后均升高(P<0.05),随后降低,D-dimer术后1周降至正常水平,而CRP在1周后仍高于术前水平(P<0.05)。腹腔镜组CRP水平显著低于开腹手术组(P<0.01)。术前CRP与D-dimer间具有正相关性(r=0.432,P<0.05)。结论血清D-dimer、CRP水平与CRC及其病变程度相关,可能对CRC的早期诊断、预后判断以及术后炎性反应判断具有指导意义。

Objective To evaluate the clinical significance of serum D-dimer and C-reactive protein（ CRP） detection in patients with colorectal carcinoma. Methods Fifty-three patients and thirty healthy controls were enrolled and bloods were sampled from controls at examination and patients pre-operation and on days 1,3,7 post-operation respectively. Serum D-dimer and CRP were detected. The results were analyzed considering the pathologic parameters such as TNM staging,lymph nodes metastasis and vascular invasion. Contrastive analyses were performed between the measurements of laparoscopic and open resection cases. Results D-dimer and CRP levels in patients were significantly higher than in controls（ P〈0. 01）. D-dimer and CRP levels in patients with lymph nodes metastasis or vascular invasion were significantly higher than in negative cases. Serum D-dimer and CRP were increased by the TNM stages promotion. Serum D-dimer and CRP were both increased post-operation and then decreased. D-dimer was attenuated to normal level and CRP was still significantly higher than pre-operation at 7 days post-operation. CRP in patients undergoing laparoscopic resection were significantly lower than in those undergoing open resection. Pre-operative CRP and D-dimer were positively correlated（ r =0. 432,P〈0. 05）. Conclusions Serum D-dimer and CRP are correlated with pathologic degrees in CRC; combined measurements of these two indexes may be significant in early diagnosis,prognosis and post-operative inflammation judgment in CRC.