CA19-9联合血常规及肝功能指标对胰腺癌的诊断价值评估

Evaluation of CA19-9 combined with indicators of blood routine and liver function in the diagnosis of pancreatic cancer

目的探讨糖类抗原19-9(CA19-9)、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、碱性磷酸酶(ALP)和直接胆红素(DBIL)与胰腺癌临床病理特征的关系及其联合检测在胰腺癌诊断中的意义,为胰腺癌的早期诊断和预后评估提供参考。方法纳入该院185例胰腺癌患者(胰腺癌组)、91例胰腺良性占位病变患者(胰腺良性占位病变组)和90例健康人(健康组)为研究对象。比较不同组别之间,不同胰腺癌TMN病理分期和临床分期之间PLR、NLR、CA19-9、ALP和DBIL水平的差异。采用Spearman相关分析指标间的相关性,绘制受试者工作特征曲线(ROC曲线),分析各指标单独及联合检测对胰腺癌的诊断价值。结果胰腺癌组的PLR、NLR、CA19-9、ALP、DBIL水平均高于健康组和胰腺良性占位病变组,差异均有统计学意义(P<0.05)。胰腺癌患者CA19-9水平与NLR呈正相关(r=0.18,P<0.05),PLR、NLR、ALP、DBIL之间两两呈相关(P<0.05)。对胰腺癌的病理分期分析结果显示,T4期较T1期和T2期CA19-9水平显著升高(P<0.05);N2期较N0期NLR显著升高,N2期较N0期和N1期CA19-9水平显著升高(P<0.05);M1期较M0期NLR和CA19-9水平显著升高,DBIL水平显著降低(P<0.05)。对胰腺癌临床分期结果显示,随着临床分期增加,胰腺癌患者PLR、NLR、CA19-9水平升高,DBIL水平降低;Ⅳ期较Ⅰ期和Ⅱ期CA19-9水平显著升高,Ⅲ期较Ⅱ期CA19-9水平显著升高,Ⅳ期较Ⅰ期DBIL水平显著降低,差异均有统计学意义(P<0.05)。CA19-9、PLR、ALP、DBIL联合检测时,ROC曲线下面积最大(0.974),且灵敏度最高(86.49%)。结论CA19-9、血常规和肝功能指标与胰腺癌的病理分期及临床分期密切相关,CA19-9、PLR、ALP、DBIL联合检测可提高胰腺癌的诊断效能,对胰腺癌的早期诊断和预后判断有一定的指导意义。

Objective To investigate the relationship between carbohydrate antigen 19-9(CA19-9),platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR),alkaline phosphatase(ALP),direct bilirubin(DBIL)and the clinicopathological features of pancreatic cancer and the significance of combined detection in the diagnosis of pancreatic cancer,to provide reference for early diagnosis and prognosis evaluation of pancreatic cancer.Methods A total of 185 patients with pancreatic cancer(pancreatic cancer group),91 patients with benign pancreatic lesions(benign pancreatic lesions group)and 90 healthy subjects(healthy group)were selected.The levels of PLR,NLR,CA19-9,ALP and DBIL were compared among different groups and among patients with pancreatic cancer of different TMN pathological stages and clinical stages.Spearman correlation was used to analyze the correlation between indicators.The receiver operating characteristic curve(ROC curve)was used to analyze the diagnostic value of single and combined detection of each index for pancreatic cancer.Results The levels of PLR,NLR,CA19-9,ALP and DBIL in pancreatic cancer group were significantly higher than those in benign pancreatic lesions group and healthy group(P<0.05).The level of CA19-9 in patients with pancreatic cancer was positively correlated with the level of NLR(r=0.18,P<0.05),and PLR,NLR,ALP and DBIL were positively correlated with each other(P<0.05).The results of analysis of pathological stage showed that the level of CA19-9 in T4 stage was significantly higher than that in T1 and T2 stage(P<0.05),NLR in N2 stage was significantly higher than that in N0 stage,CA19-9 level in N2 stage was significantly higher than that in N0 stage and N1 stage(P<0.05),NLR and CA19-9 level in M1 stage was significantly higher than that in M0 stage,while DBIL level was significantly lower than that in M0 stage(P<0.05).The results of clinical staging of pancreatic cancer showed that with the increase of clinical stage,the levels of PLR,NLR and CA19-9 increased while the level of DBIL decreased.The level of CA19-9 in stageⅣwas significantly higher than that in stageⅠandⅡ.The level of CA19-9 in stageⅢwas significantly higher than that in stageⅡ,and the level of DBIL in stageⅣwas significantly lower than that in stageⅠ(P<0.05).The area under the curve(AUC)of combined detection of CA19-9,PLR,ALP and DBIL was the largest(0.974)and the sensitivity was the highest(86.49%).Conclusion CA19-9,blood routine and liver function-related parameters are closely related to the pathological and clinical stages of pancreatic cancer.Combination of with multi-indicator detection can improve the diagnostic efficiency of pancreatic cancer and has a certain guiding significance for early diagnosis and prognosis of pancreatic cancer.