丙氨酸氨基转移酶和血红蛋白在结直肠癌筛查中的临床价值

Diagnostic value of alanine aminotransferase and hemoglobin for colorectal cancer

目的探究丙氨酸氨基转移酶(alanine aminotransferase,ALT)和血红蛋白(hemoglobin,Hb)在结直肠癌筛查中的临床价值。方法选取2014年1月-2017年6月在解放军总医院确诊的原发且临床病理资料完整的结直肠癌患者123例、结直肠息肉患者87例和同期体检健康者324例的临床资料,对三组血常规指标及血清肝功能指标进行比较。结果单因素分析显示结直肠癌组血红蛋白、红细胞比积、平均红细胞体积、平均红细胞血红蛋白量、平均红细胞血红蛋白浓度、单核细胞比例、血小板计数、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、直接胆红素显著低于正常对照组和结直肠息肉组,差异有统计学意义(P<0.01)。诊断结直肠癌Hb+ALT组合较为理想,ROC曲线下面积(AUC:0.816;95%CI:0.760~0.871),灵敏度为89.7%,特异度为57.7%,二分类Logistic回归模型对结直肠癌和结直肠息肉的鉴别诊断准确率为73.3%。结论血清ALT与Hb联合检测可为结直肠癌的早期鉴别及诊断提供一定的参考依据。

Objective To explore the diagnostic value of alanine aminotransferase and hemoglobin for colorectal cancer. Methods Clinical data about 123 newly diagnosed colorectal cancer patients, 87 cases of colorectal polyps and 324 healthy controls in Chinese PLA General Hospital from January 2014 to June 2017 were collected. The blood routine indicators and serum liver function indicators were compared between three groups. Results Univariate analysis showed that hemoglobin（Hb）, hematocrit（HCT）, mean corpuscular volume（MCV）, mean red blood cell hemoglobin（MCH）, mean erythrocyte hemoglobin concentration（MCHC）, monocyte platelet count（PLT）, alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, direct bilirubin（DBil） in the colorectal cancer group were significantly lower than those in healthy control group and colorectal polyps group, and the differences were statistically significant（all P〈0.01）. Hb＋ALT was the best indicator for diagnosing colorectal cancer. Area under ROC curve of Hb＋ALT was 0.816（95% CI, 0.760 to 0.871）, and the sensitivity and specificity were 89.7% and 57.7% respectively. The accuracy of the binary logistic model for differential diagnosis of colorectal cancer and colorectal polyps was 73.3%. Conclusion The combination of ALT and Hb can be used in the early differentiation and diagnosis of colorectal cancer.