血常规、凝血四项联合CEA、CA19-9在结直肠癌诊断中的价值

The value of blood routine,coagulation four indices combined with CEA and CA19-9 in the diagnosis of colorectal cancer

目的:对结直肠癌(Colorectal cancer,CRC)患者的临床特征进行比较分析,并对血常规、凝血四项联合CEA、CA19-9在结直肠癌诊断中的价值进行评价。方法:选择2017年1月~2020年12月在广州医科大学附属中医医院患者进行回顾性病例对照研究,CRC患者为病例组,大肠息肉患者为对照组,采用受试者工作特征曲线(ROC)和logistic回归模型进行诊断分析。结果:CRC组和对照组分别有58例和60例患者纳入分析。CRC的平均年龄、潜血阳性率、3项凝血指标(FIB、PT和INR)和肿瘤标志物(CEA和CA19-9)均显著高于对照组(P<0.05),而血常规的红细胞和血红蛋白则相反。除了APTT、TT和PLT外,其余指标对CRC的诊断具有统计学意义,AUC最大的指标是CEA(0.80),当CEA最佳诊断界值分别为3.67 ng/ml,其灵敏度和和特异度为0.69和0.78。INR、PT和RBC的AUC分别为0.78、0.77和0.73,将上述AUC面积排前4的指标进行联合诊断发现,CEA+PT+INR+RBC的AUC为0.86(P<0.001),在联合预测值P=1/[ 1+e^(-/-[-10.07-3.75X_(PT)+54.52X_(INR)+0.11X_(CEA)-0.52X_(RBC)])]为0.48时最佳,灵敏度和特异度分别为0.74和0.85。结论:CEA+PT+INR+RBC联合诊断可显著提高CRC的诊断效能。

Objective:To comparative analysis of clinical characteristics of patients with colorectal cancer(CRC),and to evaluate the value of blood routine,coagulation four indices combined with CEA and CA19-9 in the diagnosis of colorectal cancer.Methods:A retrospective case control study was conducted on patients admitted to the hospital of the affiliated TCM hospital of guangzhou medical university from January 2017 to December 2020.CRC patients were selected for the case group,and the patients with colorectal polyp were selected for the control group.The receiver operating characteristic curve(ROC)and logistic regression model were used for diagnostic analysis.Results:58 patients of the case group and 60 patients of the control group were included in the analysis.The indicators in the case group,including the average age,the positive rate of occult blood,3 coagulation indexes(FIB,PT and INR),and tumor markers(CEA and CA19-9),were significantly higher than those of the control group,P values were all less than 0.05.While the red blood cells counts and hemoglobin had the opposite results.Except for APTT,TT,and PLT,other indicators had statistically significant differences in the diagnosis of CRC.The indicator with the largest area under the curve(AUC)was CEA(0.80).When the best diagnostic threshold of CEA was 3.67 ng/ml,the sensitivity and specificity are 0.69 and 0.78,respectively.The AUC of INR,PT,and RBC were 0.78,0.77,and 0.73,respectively.The indicators with AUC ranked top four were combined to diagnose CRC,It was found that the AUC of CEA+PT+INR+RBC was 0.86(P<0.001).When the joint prediction value(P=1/[1+e^(-[-10.07-3.75X_(PT)+54.52X_(INR)+0.11 X_(CEA)-0.52 X_(RBC)])])was 0.48,there was a maximum Youden index,the sensitivity and specificity were 0.74 and 0.85,respectively.Conclusion:The combined diagnosis of CEA+PT+INR+RBC could significantly improve the diagnostic efficiency of CRC.