血清肿瘤标志物联合D-二聚体对NSCLC患者VTE的诊断

Diagnosis of Venous Thromboembolism in NSCLC Patients with Serum Tumor Markers Combined with D-dimer

目的探讨血清肿瘤标志物联合D-二聚体对非小细胞肺癌(non-small cell lung cancer,NSCLC)患者发生静脉血栓栓塞症(venous thromboembolism,VTE)的预测诊断价值,方法冋顾2016年1月~2018年12月在徐州医科大学附属医院住院的NSCLC合并VTE患者117例,并与同期NSCLC非VTE患者386例的癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原(cancer antigen 125,CAI25)、神经元烯醇化酶(neuron-specific enolase,NSE)、肺癌抗原(cytokeratin-19-fragment,CYFRA21-1)、D-二聚体进行比较。血清肿瘤标志物通过二元Logistic回归分析危险因素。采用ROC曲线评价血清肿瘤标志物和D-二聚体对VTE的诊断价值及联合诊断价值。结果NSCLC合并VTE患者的CA125.CYFRA21-1及D-二聚体均明显高于非VTE组,差异有统计学意义(PV0.05),两组CEA、NSE比较,差异无统计学意义(P>0.05)。通过二元Logistic回归分析,CA125、D-二聚体升高是VTE的危险因素,CA125、CYFRA21-1、D-二聚体对NSCLC合并VTE预测的曲线下面积(area under the curve,AUC)分别为0.707,0.561和0.728(P<0.05)。CA125预测NSCLC合并VTE的敏感度为67.5%,特异性为63.7%,截断值为38.72;CYFRA21-1预测NSCLC合并VTE的敏感度为34.2%,特异性为80.1%,截断值为12.54;D-二聚体预测NSCLC合并VTE的敏感度为60.7%,特异性为78.3%,截断值为1.56 CA125联合D-二聚体预测AUC为0.773,敏感度为64.1%,特异性为81.3%。结论血清肿瘤标志物CA125联合D-二聚体可以提高NSCLC患者VTE的临床诊断价值。

Objective To investigate the predictive diagnostic value of serum tumor markers combined withD-dimer for venous thromboembolism(VTE)in patients with non-small cell lung cancer(NSCLC).Methods 117 NSCLC patients with VTE who were admitted to the affiliated hospital of XuZhou medical university from January 2016 to December 2018 were reviewed and compared with 386 non-VTE NSCLC patients of the same period,including CEA,CA125,NSE,lung cancer antigen(cyfra21-1)and d-dimer.Serum tumor markers were analyzed by binary logistic regression analysis.ROC curve was used to evaluate the diagnostic value of serum tumor markers and d-dimer in VTE and their combined diagnostic value.Results CAI25,cyfra21-1 and d-dimer in NSCLC patients with VTE were significantly higher than those in non-VTE group,which was statistically significant(P<0.05),while CEA and NSE were not statistically significant(P>0.05).Binary logistic regression analysis showed that the increase of CA125 and d-dimer was a risk factor for VTE,and the prediction of area under curve(AUC)of CA125,cyfra21-1 and d-dimer for NSCLC combined with VTE was 0.707,0.561 and 0.728,respectively(all P<0.05).CA125 predicted the sensitivity,specificity and cut-off value of NSCLC combined with VTE of 67.5%,63.7%and 38.72,respectively.The sensitivity and specificity of cyfra21-1 were 34.2%,80.1%and 12.54 respectively.D-dimer predicted the sensitivity,specificity and truncated value of NSCLC combined with VTE of 60.7%,78.3%,1.56.The AUC of CA 125 combined withD-dimer was 0.773,the sensitivity was 64.1%,and the specificity was 81.3%.Conclusion Serum tumor marker CA125 combined with d-dimer can improve the clinical value of VTE in NSCLC patients.