D-二聚体与肿瘤标记物联合检测对胃癌患者的诊断价值

Diagnostic value of simultaneous detection of D-dimer and tumor markers in gastric cancer

目的探讨D-二聚体与肿瘤标记物联合检测对胃癌患者的诊断价值。方法选取2017年5月至2018年5月间西安市长庆油田职工医院收治的63例胃癌患者为A组,选取同期41例胃良性病变患者为B组,同期30例体检健康者为C组。检测并比较三组受试者D-二聚体与糖类抗原199(CA199)、癌胚抗原(CEA)及糖链抗原72-4(CA72-4)等肿瘤标记物水平。结果 A组患者D-二聚体与CA199、CEA及CA72-4水平与B组和C组比较,差异均有统计学意义(均P<0.05)。A组Ⅰ期患者D-二聚体和CA199、CEA及CA72-4水平与C组比较,差异无统计学意义。A组Ⅱ期患者CA72-4水平与C组比较,差异有统计学意义(P<0.05)。A组Ⅲ期和Ⅳ期患者D-二聚体和各肿瘤标记物水平与C组比较,差异均有统计学意义(均P<0.05)。A组Ⅱ期、Ⅲ期和Ⅳ期患者联合检测阳性率均高于单项检查阳性率,差异均有统计学意义(均P<0.05)。D-二聚体单项检测中敏感度最高,CA72-4的敏感度和特异度相较于其他肿瘤标志物均较高。联合检测中,D-二聚体联合CA199和CA72-4的敏感度最高,为93.7%。结论 D-二聚体与CA199、CEA及CA72-4等肿瘤标记物水平随胃癌的分期进展而不断增高。其中D-二聚体阳性检出率较高,与肿瘤标记物联合应用,能进一步提升胃癌诊断的敏感度与特异度,有临床应用价值。

Objective To study the clinical value of D-dimer combined with tumor markers in the diagnosis of gastric cancer.Methods From May 2017 to May 2018,63 patients with gastric cancer treated at Changqing Oilfield Workers＇ Hospital were selected as group A.Forty-one patients with benign gastric lesions were selected at the same time as group B.Another 30 healthy patients whohad health examinations at the same time were selected as group C.Tumor markers such as carbohydrate antigen 199（CA199）,carcinoembryonic antigen（CEA）,carbohydrate antigen 72-4（CA72-4） were detected and compared.Results A set of D-dimer,CA199,CEA,and CA72-4 levels were significantly different between group A and group B and group C（all P〈0.05）.There was no significant difference in D-dimer,CA199,CEA,and CA72-4 levels between stage Ⅰ patients in group A and group C（P〈0.05）. However,for stage Ⅱ patients,there was significant difference in the above levels between group A and group C（all P〉0.05）.This was also true for stage Ⅲ,Ⅳ patients（all P〈0.05）.For group A,the positive detection rate was higher for combined detection of the above tumor markers than for the single detection alone in all stage Ⅱ,stage Ⅲ and stage Ⅳ patients（all P〈0.05）.The sensitivity was the highest for D-dimer alone and the sensitivity and specificity were higher for CA72-4 than other tumor markers.In the combination detection,the sensitivity reached the highest when D-dimer was combined with CA199 and CA72-4（93.7%）.Conclusion The level of tumor markers including D-dimer,CA199,CEA and CA72-4 increased with the staging of gastric cancer.Among them,the positive detection rate of D-dimer is high,and when combined with other tumor markers can further improve the sensitivity and specificity of gastric cancer diagnosis,which has clinical value.