同型半胱氨酸、叶酸检测在结肠息肉和结肠癌诊断中的意义

Clinical significance of homocysteine and folic acid in the diagnosis of colonic polyp and colon cancer

目的探讨同型半胱氨酸(Hcy)、叶酸(FA)检测在结肠息肉和结肠癌患者诊断中的临床意义。方法选择山东大学附属济南市中心医院2018年10月至2019年10月诊治的结肠癌患者35例(结肠癌组)、结肠息肉患者70例(结肠息肉组:增生性息肉组、腺瘤性息肉组各35例)及健康志愿者30例(对照组)为研究对象,检测并比较血清Hcy、FA水平的差异,分析血清Hcy、FA对结肠息肉、结肠癌鉴别诊断的价值。结果结肠癌组血清Hcy、FA分别为(18.4±5.1)μmol/L、(5.2±1.4)ng/L,增生性息肉组分别为(15.1±5.1)μmol/L、6.5±2.1)ng/L,腺瘤性息肉组分别为(15.9±4.2)μmol/L、(6.8±2.3)ng/L,对照组分别为(9.2±3.2)μmol/L、(7.5±2.1)ng/L,差异均有统计学意义(F=23.584、7.671,均P<0.05)。与增生性息肉组、腺瘤性息肉组比较,结肠癌组Hcy水平更高、FA水平更低,差异均有统计学意义(t=4.328、3.279、3.844、4.731,均P<0.05)。增生性息肉组与腺瘤性息肉组Hcy、FA差异均无统计学意义(均P>0.05)。Hcy鉴别结肠癌、结肠息肉的曲线下面积为0.815,最佳界值为18.1μmol/L,对应诊断灵敏度、特异度分别为81.1%、74.8%;FA鉴别结肠癌及结肠息肉的曲线下面积为0.172,最佳界值为5.5 ng/L,对应诊断灵敏度、特异度分别为80.5%、76.9%。结论检测血清Hcy、FA有助于结肠息肉与结肠癌的诊断和鉴别诊断。

Objective To investigate the clinical significance of homocysteine(Hcy)and folic acid(FA)detection in the diagnosis of patients with colon polyps and colon cancer.Methods From October 2018 to October 2019,35 patients with colon cancer(colon cancer group)and 70 patients with colon polyps(colon polyps group:hyperplastic polyp group and adenomatous polyp group,each group in 35cases)diagnosed and treated in Ji'nan Central Hospital Affiliated to Shandong University were selected in the study,and 30 healthy volunteers were selected as control group.The serum Hcy and FA levels of the patients with colon cancer and colon polyps and the control group were detected and compared.The value of serum Hcy and FA in the differential diagnosis of colon polyps and colon cancer was analyzed.Results The serum levels of Hcy and FA in the colon cancer group were(18.4±5.1)μmol/L and(5.2±1.4)ng/L,respectively,which in the hyperplastic polyp group were(15.1±5.1)μmol/L and(6.5±2.1)ng/L,respectively,which in the adenomatous polyp group were(15.9±4.2)μmol/L and(6.8±2.3)ng/L,respectively,which in the control group were(9.2±3.2)μmol/L and(7.5±2.1)ng/L,respectively,the differences were statistically significant(F=23.584,7.671,all P<0.05).Compared with the hyperplastic polyp group and the adenomatous polyp group,the Hcy level in the colon cancer group was higher and the FA level in the colon cancer group was lower,the differences were statistically significant(t=4.328,3.279,3.844,4.731,all P<0.05).There were no statistically significant differences in Hcy and FA between the hyperplastic polyp group and the adenomatous polyp group(all P>0.05).The area under the curve of Hcy for the identification of colon cancer and colon polyps was 0.815,and the optimal limit was 18.1μmol/L,the corresponding diagnostic sensitivity and specificity were 81.1%and 74.8%,respectively.The area under the curve of FA for the identification of colon cancer and colon polyps was 0.172,and the optimal threshold was 5.5ng/L,the corresponding diagnostic sensitivity and specificity were 80.5%and 76.9%,respectively.Conclusion Detection of serum Hcy and FA is helpful for the diagnosis and differential diagnosis of colon polyps and colon cancer.