血清GDF15诊断及筛查结直肠癌的临床价值

Serum Growth Differentiation Factor-15 Levels in the Diagnosis and Screening of Colorectal Cancer

[目的]通过较大样本回顾性研究生长分化因子15(GDF-15)在结直肠癌中的诊断价值,并探索GDF15及多肿瘤标志物联合应用辅助诊断早期结直肠癌的临床意义。[方法]应用GDF15定量检测试剂及化学发光免疫分析法,分别检测未接受治疗结直肠癌患者(441例)、治疗后四周结直肠癌患者(179例)和正常健康人群(617名)血清样本中GDF15、CA19-9和CEA水平,探索结直肠癌患者血清GDF15水平与临床分期等临床特征的相关关系,以及GDF15与CA19-9、CEA联用筛查早期结直肠癌的可能性。[结果]结直肠癌患者血清GDF15水平显著高于正常人群(P<0.001),且其血清水平随患者临床分期进展而显著上升(P<0.001),与肿瘤浸润程度(P=0.04)、淋巴结转移与否(P=0.017)、是否存在远端转移(P<0.001)及发病部位(直肠vs结肠,P=0.007)均显著相关。血清GDF15作为肿瘤标志物诊断结直肠癌的灵敏度显著高于CA19-9和CEA(52.4%vs 14.5%,36.3%),尤其在诊断早期结直肠癌患者时,其灵敏度差异更为显著(Ⅰ期43.4%vs 5.7%,7.5%;Ⅱ期55.0%vs 12.9%,35.0%);GDF15与CEA联合应用诊断结直肠癌的灵敏度可达68.3%,其中Ⅰ期结直肠癌灵敏度为49.1%,Ⅱ期结直肠癌灵敏度为70.0%。[结论]GDF15与结直肠癌的临床进展显著相关,是结直肠癌尤其是早期结直肠癌有价值的血清肿瘤标志物,GDF15和CEA联合检测用于结直肠癌早期筛查具有重要的辅助价值。

[Purpose]To investigate the diagnostic value of serum growth differentiation factor-15(GDF15)level in patients with colorectal cancer(CRC).[Methods]The serum levels of GDF15,CA19-9 and CEA were analyzed by GDF15 quantitative detection reagent and chemiluminescence immunoassay in 441 untreated CRC patients,179 CRC patients 4 weeks after treatment and 617 healthy subjects,respectively.The association of the serum levels of GDF15 with clinical characters were analyzed.Additionally,the clinical value of combining GDF15 with CA19-9 and CEA was explored in screening of colorectal cancer.[Results]The serum levels of GDF15 in patients with CRC were significantly higher than those in healthy control(P<0.001).A stepwise increase of GDF15 levels was noted with the progress of colorectal cancer(P<0.001),and the levels were significantly correlated with the depth of tumor invasion(P=0.04),lymph node metastasis(P=0.017),remote metastasis(P<0.001)and the location of CRC(P=0.007).The sensitivity of GDF15 was superior to CA19-9 and CEA(52.4%vs 14.5%,36.3%).The sensitivities of GDF15 were 43.4%and55.0%in stageⅠand stageⅡCRC respectively,significantly higher than those of CA19-9(stageⅠ,5.7%;stageⅡ,12.9%)and CEA(stageⅠ,7.5%;stageⅡ,35.0%).Furthermore,GDF15 combined with CEA had a sensitivity of 68.3%in the diagnosis of CRC,that was 49.1%for stageⅠCRC and 70.0%for stageⅡCRC.[Conclusion]GDF15 is significantly related to the clinical stages of CRC.The combination of GDF15 with CEA may be more sensitive in diagnosis and screening of early-stage CRC.