血清CA199、C3、C4及脂类代谢水平在胰腺癌临床诊断中的应用

Application of levels of serum CA199,C3,C4 and lipid metabolism in clinical diagnosis of pancreatic cancer

目的:评估单独及联合检测血清CA199、补体3(C3)、补体4(C4)、总胆固醇(TC)和脂类代谢水平在胰腺癌临床诊断中的应用价值,并探讨上述指标与胰腺癌TNM分期及病理分期的关系。方法:收集77例胰腺癌患者(Pc组)、58例非消化系统肿瘤患者(Ndc组)和50名健康对照者(Hc组)共185例血清,测定各组受试者血清CA199、C3、C4以及甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)和脂蛋白a[Lp(a)]等脂代谢水平,并对结果进行统计分析。结果:(1)Pc组患者血清CA199水平显著高于Ndc组和Hc组(P<0.01),而Ndc组与Hc组比较差异无统计学意义(P>0.05);Pc组和Ndc组患者血清C3、C4及ApoE水平显著高于Hc组(P<0.01),且Pc组显著高于Ndc组(P<0.01);Pc组患者血清HDL-C、ApoA和Lp(a)水平低于Ndc组和Hc组(P<0.05)。(2)Pc组患者血清CA199、C3、C4、ApoE、HDL-C、ApoA受试者工作特征曲线(ROC)下面积(AUC)分别为0.916、0.841、0.788、0.785、0.834和0.810,对胰腺癌均具有一定诊断价值;多因素联合分析,联合检测血清CA199、C3和HDL-C(AUC=0.968)较单独检测CA199具有更高的诊断价值(P<0.05)。(3)TNM分期,Ⅲ-Ⅳ期胰腺癌患者血清CA199水平显著高于Ⅰ-Ⅱ期患者(P<0.01);而病理分期中高分化组患者血清ApoA水平明显低于低分化组患者(P<0.05),其他指标比较差异无统计学意义(P>0.05)。结论:胰腺癌患者血清CA199、C3、C4及ApoE水平明显升高,而HDL-C、ApoA以及Lp(a)水平明显降低;在胰腺癌早期诊断中,联合检测血清CA199、C3和HDL-C优于各指标单项评估。

Objective： To evaluate the diagnostic values of single and combined detection of serum CA199, complement 3 （C3）, complement 4 （C4）, total cholesterol （TC）, triglyceride （TG）, and lipid metabolism levels in the patients with pancreatic cancer, and to explore their correlations with TNM stage and pathological stage of pancreatic cancer. Methods： Total 185 subjects were enrolled into the study by three groups： pancreatic cancer patients group （Pc group, n=77）, non-digestive system cancer patients group （Ndc group, n= 58） and healthy control group （Hc group, n=50）. The levels of serum CA199, C3, C4, and high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, apolipoprotein A （ApoA）, apolipoprotein g （ApoB）, apolipoprotein E （ApoE）, and lipoprotein a （Lpa） levels were detected. Results： （i） The serum level of CA199, C3, C4, and ApoE of the patients in Pc group were higher than those in Ndc and Hc groups （P〈0.01）. No statistical difference was observed in the serum CA199 between Ndc and Hc groups （P〉0.05）. The levels of C3, C4, and ApoE in Pc group and Ndc group was higher than those in Hc group （P〈0.01）, and the levels of the biomarkers in Pc group were also higher than those in Ndc group （P〈0.01）. The levels of HDL-C, ApoA and Lp （a） of the patients in Pc group were significantly lower than those in Ndc and He groups （P〈0.05）. The area under ROC curve （AUC） of serum CA199, C3, C4, ApoE, HDL-C, and ApoA were 0.916, 0.841, 0. 788, 0. 785, 0. 834, and 0. 810, respectively. Furthermore, multiple factor analysis showed that the combined detection of CA199, C3, and HDL-C （AUC=0. 968） improved the diagnosis compared with detecting CA199 alone （P〈0.05）. @ The CA199 level of the patients in Ⅲ-Ⅱ stage of TNM stage was higher than that in the patients in I-Ⅱ stage （P〈0.01）. For the pathological stage, the ApoA level in low differentiation group was higher than that in moderate and high differentiation group （P〈0.05）. There was no statistical difference in other biomarkers between the different TNM stages and pathological stages. Conclusion： The levels of CA199, C3, C4 and ApoE of pancreatic cancer patients are significantly increased, while the levels of HDL-C, ApoA, and Lp （a） are significantly reduced. Combined detection of CA199, C3, and HDL-C can improve the early diagnosis of pancreatic cancer compared with the single assessment of each biomarker.