结直肠癌患者血清CEA和D-二聚体检测临床意义

Clinical significance of CEA and D-dimer levels in patients with colorectal cancer

目的结直肠癌(colorectal cancer,CRC)是全球范围内最为常见的恶性肿瘤之一,目前仍缺少有效的早期诊断及预后监测指标。本研究探讨结直肠癌患者术前和术后癌胚抗原(carcinoembryonic antigen,CEA)和D-二聚体水平的变化及二者水平与肿瘤分期和临床预后的关系。方法根据纳入和排除标准,选取2012-06-15-2015-06-15在绵阳市第三人民医院(80例)和华中科技大学同济医学院附属武汉市中心医院(40例)就诊的结直肠癌患者120例,设为结直肠癌组。选取与结直肠癌组年龄和性别构成相匹配的非肿瘤性结直肠疾病患者120例作为对照组。记录患者基本信息和病理特征并进行术后随访;化学发光免疫测定(chemiluminescence immunoassay,CLIA)检测结直肠癌组和对照组血清中CEA含量,免疫比浊法检测结直肠癌组和对照组血浆中D-二聚体含量;分析术前血清CEA和血浆D-二聚体水平与病理特征关系,术后血清CEA和血浆D-二聚体水平与复发转移和术后生存率的关系。结果结直肠癌组和对照组年龄、性别组成、白细胞计数(white blood cell,WBC)和血小板(platelet,PLT)比较差异差异无统计学意义,P>0.05。结直肠癌组和对照组血清CEA含量分别为(26.25±5.61)和(1.88±1.02)ng/mL,差异有统计学意义,t=46.820,P<0.001;血浆D-二聚体含量分别为(291±112)和(155±86)ng/mL,差异有统计学意义,t=10.550,P<0.001。术后CEA含量为(4.58±1.15)ng/mL,显著低于术前的(26.25±5.61)ng/mL,t=41.450,P<0.001;术后血浆D-二聚体水平为(1 164±376)ng/mL,显著高于术前的(291±112)ng/mL,t=24.380,P<0.001。血清CEA含量与肿瘤分布无关,P>0.05;与肿瘤大小(F=71.600,P<0.001)、肿瘤分期(F=277.900,P<0.001)和是否转移(t=5.011,P<0.001)有关;D-二聚体含量与肿瘤分布和肿瘤大小无关,P>0.05;与肿瘤分期(F=120.500,P<0.001)和是否转移(t=2.356,P=0.020)有关。术后复发转移组CEA和D-二聚体含量分别为(22.6±11.3)和(463±247)ng/mL,显著高于未复发或转移患者的(6.9±3.3)和(228±95)ng/mL,差异有统计学意义,t值分别为9.352和6.282,均P<0.001。相关性分析结果显示,CEA和D-二聚体水平与生存率呈负相关关系,r值分别为-0.38和-0.59,均P<0.001。结论术前CEA和D-二聚体水平可预测结直肠癌病理分期,术后CEA和D-二聚体水平可监测结直肠癌复发转移,并与术后生存率呈负相关关系。

OBJECTIVE Colorectal cancer（CRC）is one of the most common malignant tumors in the world.Currently,there are still no effective indicators for early diagnosis and prognosis.Our aim is going to explore Carcinoembryonic antigen（CEA）and D-dimer levels in patients with colorectal cancer preoperatively and postoperatively and the relationship between the levels of CEA and D-dimer and tumor stage and clinical prognosis.METHODS Totally 120 cases of colorectal cancer patients from June 2012 to June 2015 in our hospital were selected and 120 non-neoplastic patients with colorectal disease in the same period were selected as a control.Basic information,pathologic features of patients and the followup data were recorded.The levels of CEA in serum were measured by chemiluminescence immunoassay（CLIA）.The levels of plasma D-dimer in colorectal cancer patients and controllers were detected by Immunoturbidity assay.We analyzed the relationship between serum CEA levels and plasma D-dimer of preoperative and tumor size,histological grade,tumor stage and metastasis.The relationship between serum CEA and plasma D-dimer levels of postoperative and recurrence,metastasis and postoperative survival were analyzed too.RESULTS There was no significant difference in age,gender,WBC and PLT between colorectal cancer group and control group（P〉0.05）.The levels of CEA and D-dimer in colorectal cancer group were significantly higher than those in control group（t=46.820,P〈0.001;t=10.550,P〈0.001）.The postoperative level of CEA of patients with colorectal cancer was significantly lower than that before operation,the postoperative D-dimer level was significantly higher than that before operation（t=41.450,P〈0.001;t=24.380,P〈0.001）.There was no correlation between CEA and tumor location（P〉0.05）,and had correlation with tumor size,tumor stage and metastasis（F=71.600,P〈0.001;F=277.9,P〈0.001;t=5.011,P〈0.001）.D-dimer level was not correlated with tumor location and tumor size（P〉0.05,P〉0.05）,which was correlated with tumor stage and metastasis（F=120.500,P〈0.001;t=2.356,P=0.020）.The postoperstive levels of CEA and D-dimer were negatively correlated with postoperative survival rate and had relationship with recurrence and metastasis（r=-0.38,P〈0.001;r=-0.59,P〈0.001;t=9.352,P〈0.001;t=6.282,P〈0.001）.CONCLUSION The levels of CEA and D-dimer postoperative were negatively correlated with postoperative survival rate and have relationship with recurrence and metastasis.