IGF-I与IGFBP-3在结直肠癌患者血清中表达的临床意义

The clinical significance and expression of serum IGF-I and IGFBP-3 in the colorectal cancer

目的 探讨血清中胰岛素样生长因子 I（IGF-I）、胰岛素样生长因子结合蛋白-3 （IGFBP-3）的表达与结直肠癌发生发展的关系.方法 病例对照研究.选取2014年7月至2016年3月就诊于辽宁省人民医院的113例结直肠癌患者作为结直肠癌（CRC）组,良性对照（N-CRC）组为同期37例结直肠良性病患者,健康对照（normal control,NC）组为同期76名健康体检者.对CRC组进行了有/无淋巴转移（M-CRC/NM-CRC）分亚组和TNM分期.通过化学发光法检测血清中IGF-I、IGFBP-3含量并计算其比值.两组间采用SNK检验,不同组间比较采用单因素方差分析（one-way ANOVA）.结果 在IGF-I浓度方面,NC、N-CRC、CRC组间呈小幅递减趋势,M-CRC与NM-CRC组间比较差异无统计学意义（F=0.343,P=0.559）,T4期低于T1＋T2期、T3期（F=6.279,P=0.003）.IGFBP-3浓度方面,CRC组（3.13 ±1.57）μg/ml与N-CRC组（3.42 ±1.32）μg/ml比较差异无统计学意义（F=3.04,P=0.09）,但CRC组显著低于NC组（4.62 ±1.10）μg/ml（F=10.88,P=0.001）,M-CRC亚组高于NM-CRC亚组（F=4.44,P〈0.05）.IGF-I/IGFBP-3比值方面,CRC组为48.85 ±29.14显著高于N-CRC 组（42.38 ±12.58）（F=5.05,P=0.02）和NC 组（42.46 ±16.24）（F=5.68,P=0.02）.IGF-I ROC曲线下面积（AUC）为0.63（95% CI 0.56~0.70）,诊断价值较低,以102.5作为IGF-I诊断临界值时灵敏度为85.8%,特异度为40.7%;IGFBP-3 ROC 曲线下面积（AUC）为0.72 （95%CI 0.64~0.78）,诊断价值中等,以3.33作为IGFBP-3诊断临界值时灵敏度为78.8%,特异度为62.8%.结论 IGF-I和IGFBP-3在结直肠癌患者血清中均呈低表达,同时与淋巴结转移、TNM分期相关.

Objective To study the expression of insulin-like growth factor I（IGF-I）and insulin like growth factor binding protein -3（IGFBP-3）in the colorectal cancer and the relations between them. Methods A case-control study was conducted.We selected 113 patients with a pathologically conformed diagnostic colorectal cancer as the colorectal cancer（CRC）group, 37 patients with colorectal benign diseases as benign control（N-CRC）group, and other 76 healthy subjects as normal control（NC）group. CRC was divided into lymphatic metastasis（M-CRC）subgroup and no lymphatic metastasis（NM-CRC） subgroup and was also categorized by TNM staging.Concentrations of serum IGF-I and IGFBP-3 were measured by chemiluminescence method.SNK test and one-way ANOVA were used for comparison between the two groups and among multi-groups, respectively.Results A slightly decreasing trend of the concentrations of serum IGF-I was observed following the sequences of the NC, N-CRC and CRC groups. Moreover,the concentrations of serum IGF-I in T4 were significantly lower than that in（T1＋T2）and T3 （F=6.279,P=0.003）.The concentration of serum IGFBP-3 in the CRC group（3.13 ±1.57）μg/ml was significantly lower than that both in the N-CRC（3.42 ±1.32）μg/ml（F=3.04,P=0.09）and the Normal group（4.62 ±1.10）μg/ml（F=10.88,P=0.001）.The concentration of serum IGFBP-3 in the M-CRC was higher than that in NM-CRC（F=4.44,P〈0.05）.The ratio of IGF-I/IGFBP-3 in the CRC group （48.85 ±29.14）was remarkably higher than that both in the N-CRC group（42.38 ±12.58）（F=5.05, P=0.02）and the Normal group（42.46 ±16.24）（F=5.68,P=0.02）.The value of diagnosis is general. The area under the ROC curve（AUC）of IGF-I was 0.63（95% CI 0.56 -0.70）, the sensitivity and specificity of IGF-I were 85.8%and 40.7%respectively when the critical value was 102.5 μg/ml.The area under the ROC curve（AUC）of IGFBP-3 was 0.72（95%CI 0.64-0.78）,the sensitivity and specificity of IGFBP-3 were 78.8%and 62.8%respectively when the critical value was 3.32 μg/ml.Conclusions The concentrations of IGF-I and IGFBP-3 were low expressed in serum of patients with colorectal cancer. Meanwhile,they are correlated with the lymphatic metastasis and TNM staging.