血清D-二聚体及肿瘤标志物水平预测老年Ⅲ~Ⅳ期肺腺癌患者合并静脉血栓栓塞的价值

Value of serum D-dimer and tumor markers levels in predicting venous thromboembolism in elderly patients with stageⅢ-Ⅳlung adenocarcinoma

目的探讨血清D-二聚体及肿瘤标志物水平对老年Ⅲ~Ⅳ期肺腺癌患者合并静脉血栓栓塞(VTE)的预测价值。方法抽取2020年1月至2022年1月河南省人民医院老年医学科和呼吸科收治的不能行手术治疗的老年Ⅲ~Ⅳ期肺腺癌患者321例,按是否合并VTE将患者分为VTE组(129例)和非VTE组(192例)。比较两组患者的血清D-二聚体、癌胚抗原(CEA)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、糖类抗原125(CA125)、糖类抗原199(CA199)及神经元特异性烯醇化酶(NSE)水平。通过二元Logistic回归分析血清D-二聚体及肿瘤标志物对老年Ⅲ~Ⅳ期肺腺癌合并VTE的危险因素。采用受试者工作特征曲线评价血清D-二聚体及肿瘤标志物对老年Ⅲ~Ⅳ期肺腺癌合并VTE的预测价值。结果老年Ⅲ~Ⅳ期肺腺癌合并VTE组与非VTE组患者血清D-二聚体、CEA、CYFRA21-1、CA125、CA199水平比较,差异均有统计学意义(P均<0.05)。进一步Logistic回归分析结果显示,D-二聚体、CEA和CYFRA21-1水平是老年Ⅲ~Ⅳ期肺腺癌患者合并VTE的危险因素(P<0.05)。D-二聚体、CEA、CYFRA21-1水平预测老年Ⅲ~Ⅳ期肺腺癌患者合并VTE的曲线下面积(AUC)分别为0.839、0.720、0.676(P<0.05)。D-二聚体联合CEA预测老年Ⅲ~Ⅳ期肺腺癌患者合并VTE的AUC为0.861,敏感性为0.868,特异性为0.671,截断值为0.771。结论血清D-二聚体、CEA、CYFRA21-1升高是老年肺腺癌患者合并VTE的危险因素,血清D-二聚体联合肿瘤标志物CEA可以提高老年Ⅲ~Ⅳ期肺腺癌患者合并VTE的临床诊断价值。

Objective To investigate the value of serum D-dimer and tumor markers levels in predicting venous thromboembolism(VTE)in elderly patients with stageⅢ-Ⅳlung adenocarcinomas.Methods A total of 321 elderly patients with inoperable stageⅢ-Ⅳlung adenocarcinoma admitted to the Department of Geriatrics and Department of Respiratory and Critical Care Medicine of Henan Provincial People’s Hospital from January 2020 to January 2022 were selected.And they were divided into VTE group(129 cases)and non-VTE group(192 cases)according to occurrence of VTE.The levels of serum D-dimer,carcinoembryonic antigen(CEA),cytokeratin fragment antigen 21-1(CYFRA21-1),carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),and neuron-specific enolase(NSE)were compared between the two groups.Binary logistic regression was used to analyze that whether serum D-dimer and tumor markers were the risk factors for VTE in elderly patients with stageⅢ-Ⅳlung adenocarcinoma.The receiver operating characteristic curve was used to evaluate the value of serum D-dimer and tumor markers in predicting VTE in elderly patients with stageⅢ-Ⅳlung adenocarcinoma.Results The levels of serum D-dimer,CEA,CYFRA21-1,CA125,and CA199 in the VTE group were significantly different from those in the non-VTE group(all P<0.05).Logistic regression analysis further showed that levels of D-dimer,CEA,and CYFRA21-1 were risk factors for VTE in elderly patients with stageⅢ-Ⅳlung adenocarcinoma.The area under the curve(AUC)of levels of D-dimer,CEA,and CYFRA21-1 for the prediction of VTE in elderly patients with stageⅢ-Ⅳlung adenocarcinoma were 0.839,0.720,and 0.676,respectively(P<0.05).The AUC of D-dimer combined with CEA in predicting VTE in elderly patients with stageⅢ-Ⅳlung adenocarcinoma was 0.861,sensitivity was 0.868,specificity was 0.671,and cut-off value was 0.771.Conclusions Elevated levels of serum D-dimer,CEA,and CYFRA21-1 are risk factors for VTE in elderly patients with lung adenocarcinoma.The combination of serum D-dimer and tumor marker CEA can enhance the clinical diagnostic value for VTE in elderly patients with stageⅢ-Ⅳlung adenocarcinoma.