热休克蛋白联合检测在结直肠癌中的诊断价值研究

Diagnostic Value of Heat Shock Protein Combined with Multiple Tumor Markers in Colorectal Cancer

目的通过测定结直肠癌(colorectal cancer,CRC)患者血清热休克蛋白60(HSP60)、癌胚抗原(CEA)、癌抗原242(CA242)、癌抗原724(CA724)及细胞角蛋白19片段抗原(CYFRA21-1)水平变化,探讨最佳检测方案。方法选取2017年6—12月唐山市人民医院收治的CRC患者156例作为CRC组,另选取同期来院体检健康者40例作为正常对照组。收集两组受试者血清,采用酶联免疫吸附双抗体夹心法测定血清HSP60水平,采用电化学发光法测定CEA、CA242、CA724、CYFRA21-1水平;分析CRC组血清HSP60水平与临床特征之间的关系;以病理诊断为金标准,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析HSP60、CEA、CA242、CA724、CYFRA21-1单项检测及不同联合检测方案对CRC的诊断效能。结果与正常对照组比较,CRC组血清HSP60、CEA、CA242、CA724和CYFRA21-1水平均有所升高,差异均有统计学意义(P<0.05或P<0.01)。CRC组血清HSP60水平与患者性别、年龄、病变部位无关(P> 0.05),TNM分期I+Ⅱ期患者血清HSP60水平低于Ⅲ+Ⅳ期患者,差异有统计学意义(P<0.01)。单项检测诊断效能分析显示,ROC曲线下面积(area under the cure,AUC):HSP60(0.858)> CEA(0.801)> CYFRA21-1(0.793)>CA724(0.708)> CA242(0.706),5种肿瘤标志物单项检测的诊断效能中等,其中HSP60单项检测的诊断效能最高。不同联合检测方案诊断效能分析显示,AUC:HSP60+CEA+CA242+CA724+CYFRA21-1(0.973)> HSP60+CEA(0.924)> CEA+CA242+CA724+CYFRA21-1 (0.916)> CEA+CA242+CA724(0.846),5种肿瘤标志物联合检测诊断效能最高,优于其他组合方案,差异均有统计学意义(P<0.01)。结论HSP60对CRC的诊断及TNM分期有较高的应用价值,HSP60+CEA+CA242+CA724+CYFRA21-1联合检测可显著提高CRC的诊断率。

Objective To investigate the changes of serum heat shock protein 60(HSP60),carcinoembryonic antigen(CEA),carcinogen 242(CA242),carcinogen 724(CA724)and cytokeratin 19 fragment antigen(CYFRA21-1)levels in patients with colorectal cancer(CRC),and to explore the diagnostic value of the optimal protocol for detection of CRC.Methods From June 2017 to December 2017,156 CRC patients who were admitted to Tangshan People's Hospital were enrolled as CRC group and 40 healthy people who underwent physical examination in our hospital during the same period served as normal control group.Serum samples of the two groups were collected and levels of serum HSP60 were determined by enzyme-linked immunosorbent double antibody sandwich method.CEA,CA242,CA724,CYFRA21-1 levels were measured by electrochemiluminescence method.The relationship between serum HSP60 level and clinical features in CRC group was analyzed.In addition,with pathological diagnosis as the gold standard,receiver operating characteristic(ROC)curve was delineated to analyze the diagnostic efficacy of HSP60,CEA,CA242,CA724,and CYFRA21-1 by single test and different combined test schemes for CRC.Results Compared with the normal control group,the serum levels of HSP60,CEA,CA242,CA724 and CYFRA21-1 in CRC group were higher(P<0.05 or P<0.01).The level of serum HSP60 in CRC group was not correlated with sex,age and lesion site(P>0.05),but there were significant differences in different TNM stages(P<0.01).Based on analysis of diagnostic efficacy by single detection,the area under ROC curve(AUC)was:HSP60(0.858)>CEA(0.801)>CYFRA21-1(0.793)>CA724(0.708)>CA242(0.706).The diagnostic efficacy of single detection of five tumor markers was moderate,and that of HSP60 was the highest.Analysis of diagnostic efficacy of different combined detection schemes showed AUC:HSP60+CEA+CA242+CA724+CYFR A21-1(0.973)>HSP60+CEA(0.924)>CEA+CA242+CA724+CYFRA21-1(0.916)>CEA+CA242+CA724(0.846).The combined detection of five tumor markers had the highest diagnostic efficacy,which was superior to other combination schemes(P<0.01).Conclusion HSP60 has a high value in the diagnosis of CRC and TNM staging.The combined detection of HSP60+CEA+CA242+CA724+CYFRA21-1 can significantly improve the diagnostic rate of CRC.