结直肠癌不同证型实验室指标分析

Analysis on the laboratory indexes of different syndromes of colorectal cancer

目的从医学检验的角度,探讨结直肠癌(CRC)脾虚气滞证和湿热蕴结证的临床实验室指标的联系。方法收集北京市昌平区中医医院肛肠科和疼痛科2018年1月至2019年1月门诊及住院结直肠癌患者脾虚气滞证组和湿热蕴结证组,每组各80例。分析两中医证型的血常规、肝肾功能、肿瘤生物标志物等临床实验室指标的差异性。结果脾虚气滞证组患者检测血小板(PLT)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血清肌酐(CRE)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、癌胚抗原(CEA)、维生素D[25(OH)D]结果水平显著高于湿热蕴结证组,差异有统计学意义(P<0.01)。脾虚气滞证组检测血红蛋白(HGB)、甲胎蛋白(AFP)、糖类抗原CA-199(CA199)、糖类抗原CA-242(CA242)、特异性生长因子(TSGF)结果显著低于湿热蕴结证组,差异有统计学意义(P<0.05)。且PLT、ALT、AST、GGT、CEA、CA242、25(OH)D的诊断准确度分别为0.805、0.756、0.740、0.736、0.787、0.807、0.721,其中PLT、CA242准确度最高。结论脾虚气滞证与湿热蕴结证之间临床实验室指标HGB、PLT、ALT、AST、CRE、ALP、GGT、AFP、CEA、CA199、CA242、TSGF、25(OH)D有显著差异,实验室指标PLT、ALT、AST、GGT、CEA、CA242、25(OH)D均可用于结直肠癌(CRC)脾虚气滞证和湿热蕴结证型的诊断,且PLT、CA242的诊断效能要优于其他指标。

Objective To investigate the correlation between clinical laboratory indexes of spleen-deficiency and qi-stagnation syndrome and damp-heat retention syndrome in colorectal cancer(CRC)from the perspective of medical examination.Methods Patients of the spleen-deficiency and qi-stagnation syndrome group(n=80)and those of the damp-heat retention syndrome group(n=80)from January 2018 to January 2019 admitted to the department of anus-intestines and department of pain clinic of Beijing Changping Hospital of Chinese Medicine were collected.The differences of clinical laboratory indexes such as blood routine,hepatic and renal function and tumor biomarkers between the two TCM syndromes were analyzed.Results The levels of platelet(PLT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatinine(CRE),alkaline phosphatase(ALP),γ-glutamyl transpeptidase(GGT),carcinoembryonic antigen(CEA)and vitamin D[25(OH)D]in patients of the spleen-deficiency and qi-stagnation syndrome group were significantly higher than those in patients of the damp-heat retention syndrome group,with statistically significant differences(P<0.05).The results of detecting hemoglobin(HGB),alpha fetoprotein(AFP),carbohydrate antigen CA-199(CA199),carbohydrate antigen CA-242(CA242)and tumor supplied group of factors(TSGF)in the spleen-deficiency and qi-stagnation syndrome group were significantly lower than those in the damp-heat retention syndrome group,with statistically significant differences(P<0.05).And the diagnostic accuracy rate of PLT,ALT,AST,GGT,CEA,CA242 and 25(OH)D were 0.805,0.756,0.740,0.736,0.787,0.807 and 0.721 respectively,among which PLT and CA242 were the highest in accuracy.Conclusion There are statistically significant differences in clinical laboratory indexes of HGB,PLT,ALT,AST,CRE,ALP,GGT,AFP,CEA,CA199,CA242,TSGF and 25(OH)D between the spleen-deficiency and qi-stagnation group.The laboratory indexes of PLT,ALT,AST,GGT,CEA,CA242,25(OH)D can be used for both the diagnoses of the spleen-deficiency and qi-stagnation syndrome and damp-heat retention syndrome in colorectal cancer(CRC).The diagnostic efficiency of PLT and CA242 is superior to other indexes.