血清人肿瘤蛋白P53在结直肠癌联合诊断及术后监测中的应用价值

The value of serum human tumor protein P53 in colorectal cancer combined diagnosis and postoperative monitoring

目的 探讨血清人肿瘤蛋白P53（TP53）检测在结直肠癌联合诊断和术后监测中的应用价值.方法 选取2016年3月至2017年4月在安徽省肿瘤医院腹部外科就诊,经病理学确诊为结直肠癌且未经手术、放疗及化疗的患者115例,同时期住院的结直肠良性疾病患者158例和健康体检者182名,用酶联免疫吸附法（ELISA）检测血清TP53水平,电化学发光法检测血清癌胚抗原（CEA）、糖类抗原199（CA199）水平,分析TP53在不同疾病、不同临床病理特征中的表达差异;选取41例结直肠癌患者,分别于术前1d和术后7d采血,分析术前术后CEA、CA199、TP53水平的表达差异;ROC曲线分析TP53单独检测及与CEA、CA199联合检测对结直肠癌的诊断价值.结果 结直肠癌组、良性疾病组及健康对照组TP53水平分别为316.0（24.6,940.8）、9.8（3.7,30.1）、1.9（1.4,2.5） μg/L,差异有统计学意义（H=260.161,P＜0.01）,结直肠癌组患者TP53水平显著高于结直肠良性疾病组和健康对照组;结直肠癌患者血清TP53水平在不同TNM分期、不同肿瘤位置、浸润深度以及有无淋巴结转移时表达有差异,但在性别、年龄以及肿瘤生长类型方面表达没有差异.41例结直肠癌患者术后7d血清TP53水平为711.5（354.9,1 068.0） μg/L,术前1d为952.6 （419.7,1 485.4） μg/L,术后7d较术前1d明显下降,差异有统计学意义（Z=-1.989,P＜0.05）,CEA、CA199术前、术后水平差异无统计学意义.TP53单独检测的敏感度（79.1％）和特异度（81.8％）远远高于CEA（39.1％、70.3％）和CA199 （47.8％、69.1％）,若TP53与CEA、CA199联合检测,敏感度（86.1％）和特异度（87.9％）可明显提高,联合检测ROC曲线下面积为0.924.结论 血清TP53对于结直肠癌的诊断及术后监测具有一定指导意义,与CEA、CA199联合检测可提高灵敏度和特异性,具有良好的临床应用价值.

Objective The aim of this paper is to investigate the application value of serum human tumor protein P53 （TP53） in the diagnosis and postoperative monitoring of colorectal cancer.Methods One hundred and fifteen patients with colorectal cancer diagnosed without colorectal cancer and without surgery,radiotherapy and chemotherapy and total of 158 patients with colorectal benign disease and 182 healthy subjects were enrolled in this study.The levels of serum carcinoembryonic antigen （CEA） and carbohydrate antigen 199 （CA199） were detected by electrochemiluminescence assay.The expression of TP53 was analyzed by ELISA.Fourth-one patients with colorectal cancer were detected with one day before operation and the first seven days after operation.The expression of CEA,CA199 and TP53 was analyzed by ROC curve.The results were compared with those of CEA and CA199 diagnostic value.Results The medians of the levels of TP53 in patients with colorectal cancer patients,colorectal benign,and healthy subjects are 316.0（24.6,940.8）,9.8（3.7,30.1） and 1.9（1.4,2.5） μg/L （H=260.161,P〈 0.01）,respectively.The level of TP53 in patients with colorectal cancer was significantly higher than that in colorectal benign and healthy subjects.The levels of serum TP53 in patients with colorectal cancer show great discrepancies in different TNM stages,different tumor location,depth of invasion and lymph node metastasis （P 〈 0.05）,but no difference in sex,age,and tumor growth type.The levels of TP53 in the same patient is 711.5 （354.9,1 068.0） μg/L in the first seven days after operation,significantly decreased when compared to it in the one day before the operation with the value of 952.6 （419.7,1485.4） μg/L （Z=-1.989,P〈 0.05）.The difference was statistically significant,and CEA,CA199 were not statistically significant.And the sensitivity （79.1%） and specificity （81.8%） of TP 53 were significantly higher than those of CEA （39.1%,70.3%） and CA199 （47.8%,69.1%）.If TP53 was combined with CEA and CA199,sensitivity （86.1%） and specificity （87.9%） can be significantly improved,in which the area of Receiver Operating Characteristic （ROC） curve was 0.924.Conclusions Serum TP53 has a certain positive significance for the diagnosis,postoperative monitoring of colorectal cancer.Combined detection with CEA and CA199 can improve the sensitivity and specificity,implicating good clinical application value.