C反应蛋白与白蛋白比值在早期胃癌辅助诊断中的价值

The value of C-reactive protein to albumin ratio in the auxiliary diagnosis of early gastric cancer

目的探讨血清C反应蛋白(CRP)与白蛋白比值(CAR)对早期胃癌的辅助诊断价值。方法收集2018年7月至2019年9月山东第一医科大学附属省立医院收治的119例早期胃癌患者(早期胃癌组)、108例胃炎患者(胃炎组)和133例胃息肉患者(胃息肉组)的临床资料行回顾性分析。比较3组的临床资料;参考文献报道方法、通过分层分析确定CAR值0.025为分界点,将早期胃癌患者分为高CAR组(≥0.025,43例)和低CAR组(<0.025,76例),比较2组患者的临床和病理资料;绘制受试者工作特征(ROC)曲线,分析术前CAR对早期胃癌的辅助诊断价值;分析早期胃癌患者手术前后CRP、白蛋白、CAR水平变化。结果胃炎组、胃息肉组和早期胃癌组患者白蛋白水平差异有统计学意义(P=0.001)。高CAR组肿瘤直径≥2 cm比例、T分期T1b期比例高于低CAR组,差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,高CAR值对鉴别早期胃癌与胃炎、早期胃癌与胃息肉均有一定价值,其中辅助鉴别诊断早期胃癌与胃炎的曲线下面积为0.633,95%置信区间:0.514~0.753,敏感度为88.4%,特异度为57.1%,P=0.034。早期胃癌组患者术后CRP、CAR水平高于术前,白蛋白水平低于术前[101.12(52.25,158.64)mg/L比0.68(0.28,1.55)mg/L、2.705(1.520,4.551)比0.016(0.007,0.037)、36(33,38)g/L比42(40,45)g/L],差异均有统计学意义(Z=-9.059、-9.059、-8.549,均P<0.001)。结论术前高水平CAR值作为基于炎症的判断指标,对早期胃癌的诊断和临床评估具有一定的参考价值,可作为早期胃癌诊断的辅助指标。

Objective To analyze the auxiliary diagnostic value of serum C-reactive protein(CRP)to albumin ratio(CAR)in early gastric cancer.Methods The clinical data of 119 patients with early gastric cancer(early gastric cancer group),108 patients with gastritis(gastritis group)and 133 patients with gastric polyps(gastric polyps group)admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from July 2018 to September 2019 were collected and analyzed retrospectively.The clinical data of the three groups were compared.The CAR value of 0.025 was determined as the dividing point by reference and hierarchical analysis.Patients with early gastric cancer were divided into high CAR group(≥0.025,43 cases)and low CAR group(<0.025,76 cases).The clinical and pathological data were compared between the two groups.The receiver operating characteristic(ROC)curve was used to analyze the value of preoperative CAR in the auxiliary diagnosis of early gastric cancer.Changes of CRP,albumin and CAR levels in patients with early gastric cancer were analyzed before and after operation.Results There was significant difference in albumin levels among the gastritis group,gastric polyps group and early gastric cancer group(P=0.001).The proportions of tumor diameter≥2 cm and T1 b stage in the high CAR group were higher than those in the low CAR group,and the differences were statistically significant(all P<0.05).ROC curve analysis showed that high CAR value was of certain value in differentiating early gastric cancer and gastritis,early gastric cancer and gastric polyps.The area under the curve for assisting in the differential diagnosis of early gastric cancer and gastritis was 0.633,95%confidence interval:0.514-0.753,sensitivity was 88.4%,specificity was 57.1%,P=0.034.The levels of CRP and CAR in early gastric cancer group after operation were higher than those before operation,and the level of albumin was lower than that before operation[101.12(52.25,158.64)mg/L vs 0.68(0.28,1.55)mg/L,2.705(1.520,4.551)vs 0.016(0.007,0.037),36(33,38)g/L vs 42(40,45)g/L](Z=-9.059,-9.059,-8.549,all P<0.001).Conclusion The high level of preoperative CAR,as an inflammatory based indicator,has certain reference value for the diagnosis and clinical evaluation of early gastric cancer,and can be used as an auxiliary indicator for the diagnosis of early gastric cancer.