异常凝血酶原联合CA50、CA19-9、CEA对结直肠癌肝转移的辅助诊断价值

Value of abnormal prothrombin combined with CA50,CA19-9,CEA in assistant diagnosis of liver metastasis from colorectal cancer

目的探讨人异常凝血酶原(PIVKA-Ⅱ)联合糖类抗原50(CA50)、甲胎蛋白(AFP)、糖类抗原19-9(CA19-9)和癌胚抗原(CEA)等其他肿瘤标志物检测在监测结直肠癌肝转移中的辅助诊断价值。方法 2018年5-11月,选取经武汉大学人民医院诊治的125例结直肠癌患者,其中结直肠癌肝转移者70例,结直肠癌无肝转移者55例,并随机抽取同期健康检查者75例作为对照组。采用化学发光法检测结直肠癌肝转移者、结直肠癌无肝转移者和健康对照者血清PIVKA-Ⅱ、CA50、AFP、CA19-9和CEA浓度,采用受试者工作特征曲线(ROC)分析各指标单独和联合诊断结直肠癌肝转移的临床价值。结果健康组、无肝转移组和肝转移组PIVKA-Ⅱ、CA50、CA19-9和CEA的浓度均依次上升,其中肝转移组显著高于无肝转移组和对照组(P<0.01),各组比较差异有统计学意义(P<0.01)。而肝转移组AFP浓度与无肝转移组、健康对照组间比较差异无统计学意义(均P>0.05)。PIVKA-Ⅱ的ROC曲线下面积为0.737(95%CI:0.649~0.825),检测结直肠癌肝转移的临界值为38.5 mAU/mL,敏感度为61.4%,特异度为85.5%,相比于CA50、CA19-9和CEA的检测,特异度有显著提高,敏感度稍低。PIVKA-Ⅱ、CA50、CA19-9和CEA联合诊断结直肠癌肝转移ROC曲线下面积为0.803,诊断价值显著高于PIVKAⅡ、CA50、CA19-9单独检测,灵敏度为81.4%,高于PIVKA-Ⅱ、CA19-9单独检测的灵敏度,特异度为80.0%,较CA50、CA19-9、CEA单独检测有显著提高。而AFP诊断结直肠癌肝转移的ROC曲线下面积为0.595,诊断价值较低,故未纳入联合诊断。结论血清PIVKA-Ⅱ可用于结直肠癌肝转移辅助诊断,与CA50、CA19-9、CEA联合检测,可弥补单项检测的不足,提高对结直肠癌肝转移的辅助诊断价值。

Objective To explore the assistant diagnostic value of serum abnormal prothrombin(PIVKA-Ⅱ) combined with other tumor markers, including Carbohydrate antigen 50(CA50), a-fetoprotein(AFP), Carbohydrate antigen 19-9(CA19-9) and Carcino-embryonic antigen(CEA). Methods From May to November 2018, 125 patients with colorectal cancer(70 with liver metastasis and 55 without organ metastasis) who were treated by People’s Hospital of Wuhan University were selected, while 75 healthy cases in health examination were included as a health group. The chemiluminescence was used to test the serum levels of PIVKA-Ⅱ, CA50,AFP, CA19-9 and CEA in colorectal cancer patients with liver metastasis, colorectal cancer patients without liver metastasis and healthy subjects. The receiver operating characteristic curve(ROC) was used to analyze the clinical value of each index in diagnosing liver metastasis of colorectal cancer alone and jointly. Results The concentrations of serum PIVKA-Ⅱ, CA50, CA19-9 and CEA in healthy controls, colorectal cancer patients with liver metastasis and colorectal cancer patients without liver metastasis were thereased, while the concentrations in colorectal cancer patients with liver metastasis were higher than those in colorectal cancer patients without liver metastasis and healthy controls(P<0.01), and the differences were statistically significant among groups(P<0.01). However,AFP concentration in colorectal cancer patients with liver metastasis was compared with colorectal cancer patients without liver metastasis and healthy controls respectively, the differences were not statistically significant(both P>0.05). ROC analysis showed that area under the ROC curve for PIVKA-Ⅱ was 0.737(95%CI 0.649-0.825), the cut-off value to discriminate colorectal cancer patients with liver metastasis was established at 38.5 m AU/mL, the sensitivity was 61.4%, the specificity was 85.5%, which the specificity was significantly improved and the sensitivity was slightly lower as compare the detection of CA50, CA19-9 and CEA. The area under the ROC curve for combined diagnosis of liver metastasis from colorectal cancer by PIVKA-Ⅱ, CA50, CA19-9 and CEA was 0.803, the diagnostic value was significantly higher than that of the detection of single PIVKA-Ⅱ, CA50 and CA19-9, the sensitivity was 81.4%, which was higher than that of the detection of single PIVKA-Ⅱ and CA19-9, and the specificity was 80.0%, which was higher than that of the detection of single CA50,CA19-9 and CEA. The area under the ROC curve for AFP in diagnosis of liver metastasis from colorectal cancer was 0.595,indicating the diagnostic value was low, so it was not included in the joint diagnosis. Conclusion Serum PIVKA-Ⅱ can be used for assistant diagnosis of liver metastasis from colorectal cancer. Combined detection of PIVKA-Ⅱ with CA50, CA19-9 and CEA can make up for the deficiency of single detection and improve the assistant diagnosis value of liver metastasis from colorectal cancer.