血清肿瘤标记物与多层螺旋CT、肠镜及病理联合检查对结直肠癌的诊断价值

Diagnostic value of serum tumor markers combined with multi-slice spiral CT,enteroscopy and pathology in colorectal cancer

目的探讨血清肿瘤标记物包括血清肿瘤坏死因子-α(TNF-α)、糖类抗原724(CA724)和癌胚抗原(CEA)联合多层螺旋CT、肠镜及病理检查对结直肠癌(CRC)及转移的诊断价值。方法将2015年2月至2018年8月于广州市中医医院住院治疗的CRC患者160例纳入研究作为CRC组,同时纳入结直肠良性疾病(包括结肠息肉、慢性结肠炎、溃疡性结肠炎)患者160例作为对照组。纳入研究者均进行了多层螺旋CT检查、肠镜检查或病理活检,采集上述人群血清标本检测TNF-α及CEA、CA724水平。结果CRC组的CEA、CA724和TNF-α水平均高于对照组,差异有统计学意义(P<0.001)。以病理检查结果作为“金标准”,肠镜、CT以及者两者与血清肿瘤标志物的三项联合检查对CRC诊断的准确度均高于80.00%。对诊断CRC,CT+肠镜+肿瘤标志物三项联合检查ROC曲线下面积为0.999,高于其他组合的曲线下面积;CT与病理检查对CRC转移预测的一致性结果显示Kappa=0.673,有较强一致性;不同TNM分期下的CEA、CA724和TNF-α水平随分期增加而增高,差异有统计学意义(P<0.05);对诊断CRC转移,病理+CT+肿瘤标志物三项联合的ROC曲线下面积为0.979,高于其他组合曲线下面积。结论血清肿瘤标记物水平与多层螺旋CT、肠镜及病理联合检查用于对CRC及CRC转移的诊断,弥补了单一诊断方法敏感度、特异度的缺陷,为临床优化筛查方案和治疗方案的选择提供更有效的参考。

Objective To explore the diagnostic value of serum tumor markers including serum tumor necrosis factorα(TNF-α),carbohydrate antigen 724(CA724),carcinoembryonic antigen(CEA)and multi-slice spiral CT,colonoscopy and pathology in colorectal cancer and metastasis.Methods From February 2015 to August 2018,160 patients with colorectal cancer and 160 patients with benign colorectal diseases including colonic polyps,chronic colitis and ulcerative colitis were selected.All patients were examined by multi-slice spiral CT,colonoscopy,surgical pathology or biopsy.Serum concentrations of TNF-α,CEA and CA724 were measured.Results The concentrations of CEA,CA724 and TNF-αin CRC group were higher than those in control group(P<0.001).The diagnostic accuracy of colonoscopy,CT and serum tumor markers for colorectal cancer was higher than 80.00%referred to the"golden standard"of pathological results.For the diagnosis of colorectal cancer,the area under the combined ROC curve of CT+colonoscopy+tumor markers is 0.999,which is higher than that under other combined curves.The consistency of CT and pathology in predicting the metastasis of colorectal cancer showed that Kappa=0.673,which had a strong consistency.The concentrations of CEA,CA724 and TNF-αin different TNM stages increased with the increase of stages(P<0.05).For the diagnosis of colorectal cancer metastasis,the area under ROC curve of pathological+CT+tumor markers was 0.979,which was higher than that under other combined curves.Conclusion The combined detection of serum tumor markers and multi-slice spiral CT,colonoscopy and pathology in the diagnosis of colorectal cancer and metastasis makes up for the deficiency of sensitivity and specificity of single diagnosis method,and provides a more powerful reference for clinical screening and treatment options.