结直肠癌患者凝血功能指标和肿瘤标志物与临床病理特征的关系

Relationship between coagulation function indexes,tumor markers and clinicopathological characteristics in patients with colorectal cancer

目的探讨结直肠癌患者的凝血功能指标和肿瘤标志物与临床病理特征的关系,为临床结直肠癌的早期诊断提供一定的参考价值。方法收集2019年10月至2020年10月在该院行住院治疗的200例结直肠癌患者(结直肠癌组)的血浆标本,行常规凝血功能指标和肿瘤标志物检测,并以100例结直肠良性病变患者(结直肠良性病变组)和100例体检健康者(健康对照组)作为对照,比较不同组别间凝血功能指标和肿瘤标志物的差异及两者之间的相关性,分析结直肠癌患者的TNM病理分期[包括原发肿瘤浸润程度(T)、区域淋巴结转移(N)、远处转移(M)]及临床分期(Ⅰ、Ⅱ、Ⅲ、Ⅳ期)与凝血功能指标和肿瘤标志物的关系。结果与结直肠良性病变组患者相比,结直肠癌组患者的活化部分凝血活酶时间、活化部分凝血活酶时间测定值比、凝血酶时间明显降低,纤维蛋白原(FIB)、D二聚体、纤维蛋白原降解产物、癌胚抗原(CEA)、糖链抗原242(CA242)、细胞角蛋白19片段(CYFRA21-1)水平明显升高,差异有统计学意义(P<0.05)。结直肠癌患者的FIB水平与CEA、CYFRA21-1水平呈正相关(r=0.159、0.150,P<0.05)。对结直肠癌患者的临床病理分期分析结果显示,T4期的FIB水平较T1期明显升高,差异有统计学意义(P<0.05);N2期的FIB、CEA、CA242、CYFRA21-1水平均较N0期明显升高,差异有统计学意义(P<0.05);M1期的CEA、CA242、CYFRA21-1水平均较M0组明显升高,差异有统计学意义(P<0.05)。对结直肠癌患者的临床分期分析结果显示,随着临床分期的增高,FIB、CEA、CA242、CYFRA21-1水平不断升高,Ⅱ、Ⅲ、Ⅳ期的FIB水平较Ⅰ期明显升高,Ⅳ期的CEA、CA242、CYFRA21-1水平较Ⅰ、Ⅱ、Ⅲ期明显升高,差异有统计学意义(P<0.05);早期(Ⅰ期)结直肠癌患者的FIB、D二聚体、CA242水平较结直肠良性病变患者明显升高,差异有统计学意义(P<0.05)。结论结直肠癌患者更容易出现血液高凝状态,并且凝血功能指标和肿瘤标志物之间存在一定的正相关关系,两者与原发肿瘤浸润程度、区域淋巴结转移、远处转移、临床分期等临床病理特征有密切关系。凝血功能指标和肿瘤标志物的联合检测可为临床结直肠癌的早期诊断提供一定的参考价值。

Objective To analyze the relationship between coagulation function indexes and tumor markers,and clinicopathological characteristics in patients with colorectal cancer to provide a specific reference value for clinical early diagnosis.Methods Plasma samples of 200 patients with colorectal cancer(colorectal cancer group)who were hospitalized in the hospital from October 2019 to October 2020 were collected for routine coagulation function indexes and tumor markers detection,100 patients with colorectal benign lesions(colorectal benign lesions group)and 100 healthy subjects(healthy control group)were taken as controls.The differences of coagulation function indexes and tumor markers among different groups were compared,and the relationship between TNM pathological stage[including the primary tumor infiltration degree(T),regional lymph node metastasis(N),distant metastasis(M)]and clinical stage(stageⅠ,Ⅱ,Ⅲ,Ⅳ)and coagulation function indexes and tumor markers was analyzed.Results Compared with patients with colorectal benign lesions,the levels of activated partial thromboplastin time,activated partial thromboplastin time value ratio and thrombin time in colorectal cancer patients were significantly lower,fibrinogen(FIB),D-dimer,fibrinogen degradation products,carcinoembryonic antigen(CEA),carbohydrate antigen 242(CA242),cytokeratin 19 fragment(CYFRA21-1)were significantly increased(P<0.05).The level of FIB was positively correlated with CEA and CYFRA21-1 in patients with colorectal cancer(r=0.159,0.150,P<0.05).The results of clinicopathological analysis showed that the FIB level in the T4 stage was significantly higher than that in the T1 stage(P<0.05);the levels of FIB,CEA,CA242 and CYFRA21-1 in N2 stage were significantly higher than those in N0 stage(P<0.05);the levels of CEA,CA242 and CYFRA21-1 in M1 stage were significantly higher than those in M0 stage(P<0.05).The results of clinical staging analysis showed that with the increase of clinical stage,the levels of FIB,CEA,CA242 and CYFRA21-1 increased continuously,FIB of stageⅡ,ⅢandⅣwas significantly higher than that of stageⅠ,and the levels of CEA,CA242 and CYFRA21-1 in stageⅣwere significantly higher than those in stageⅠ,ⅡandⅢ(P<0.05);FIB,D-dimer and CA242 in patients with early stage(stageⅠ)colorectal cancer were significantly higher than those in patients with benign colorectal lesions(P<0.05).Conclusion Patients with colorectal cancer are more likely to have hypercoagulable state,and there is a positive correlation between coagulation function indexes and tumor markers,which are closely related to the degree of primary tumor infiltration,regional lymph node metastasis,distant metastasis,TNM stage,clinical stage and other clinicopathological characteristics.The combined detection of coagulation function indexes and tumor markers can provide certain reference value for the early diagnosis of colorectal cancer.