血清糖类抗原甲胎蛋白糖类抗原50联合肝功能指标对结肠癌肝转移的诊断价值

Diagnostic value of serum CA19-9,AFP,CA50 combined with liver function indicators in liver metastasis of colon cancer

目的分析血清糖类抗原19-9(CA19-9)、甲胎蛋白(AFP)、糖类抗原50(CA50)联合肝功能指标在结肠癌肝转移中的诊断价值。方法回顾性分析河南省安阳市第五人民医院2020年8月至2022年8月收治的108例结直肠癌患者的临床资料,按照所有入组患者肿瘤细胞是否转移至肝脏将其分为转移组(35例)和未转移组(73例)。检测2组患者血清CA19-9、AFP、CA50及肝功能指标,将2组患者基线资料、血清CA19-9、AFP、CA50及肝功能指标进行对比,采用多因素Logistic回归分析筛选结直肠癌患者术后出现肝转移的危险因素,采用受试者工作特征(ROC)曲线分析血清CA19-9、AFP、CA50及肝功能指标诊断结肠癌肝转移的临床价值。结果转移组患者血清CA19-9、AFP、CA50、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、乳酸脱氢酶(LDH)水平[(168±11)kU/L、(31.8±1.7)ng/ml、(33.2±2.6)U/ml、(88±4)U/L、(54±7)U/L、(294±11)U/L]均比未转移组[(14±6)kU/L、(17.0±1.6)ng/ml、(17.7±1.3)U/ml、(68±5)U/L、(17±4)U/L、(180±11)U/L]高(t=75.551、42.670、33.827、21.131、27.143、51.860,P均<0.05);单因素分析结果显示,转移组中TNM分期为Ⅲ~Ⅳ期、浸润深度侵及浆膜层、组织分化程度为低、中分化的患者占比(68.6%、71.4%、85.7%)相较于未转移组(30.1%、24.7%、13.7%)上升(χ^(2)=14.292、21.597、52.614,P均<0.05);多因素Logistic回归分析结果显示,结直肠癌患者术后出现肝转移的危险因素在于TNM分期、CA19-9、AFP、CA50、ALP、GGT、LDH(P均<0.05);ROC曲线分析结果显示,血清CA19-9、AFP、CA50、ALP、GGT、LDH指标联合检测的曲线下面积(AUC)值为0.887,高于上述指标单项检测AUC值,且联合检测的敏感度、特异度、准确度分别为81.2%、87.3%及83.0%,均高于单项指标检测。结论血清CA19-9、AFP、CA50、ALP、GGT、LDH水平与结肠癌肝转移有密切联系,联合检测上述指标可弥补单项指标检测的不足,具有较高的诊断价值,可为临床该疾病治疗方案的制定提供参考依据。

Objective To explore the diagnostic value of serum carbohydrate antigen 19-9(CA19-9),alpha fetoprotein(AFP),carbohydrate antigen 50(CA50)combined with liver function indicators in liver metastasis of colon cancer.Methods A retrospective analysis was conducted on the clinical data of 108 colorectal cancer patients admitted to the Fifth People′s Hospital of Anyang from August 2020 to August 2022.All enrolled patients were divided into a metastatic group(35 cases)and a non metastatic group(73 cases)based on whether their tumor cells had metastasized to the liver.The serum CA19-9,AFP,CA50,and liver function indicators of two groups of patients were detected.The baseline data,serum CA19-9,AFP,CA50,and liver function indicators of the two groups of patients were compared.Using multifactorial logistic regression analysis to screen the risk factors for postoperative liver metastasis in colorectal cancer patients.Using the receiver operating characteristic(ROC)curve to analyze the risk factors for liver metastasis in patients with serum CA19-9,AFP,CA50 and liver function indexes to diagnose liver metastasis of colorectal cancer.Results The serum CA19-9,AFP,CA50,Alkaline phosphatase(ALP),7-glutamyl transpeptidase(GGT),lactate dehydrogenase(LDH)levels in the metastatic group were[(168±11)kU/L,(31.8±1.7)ng/ml,(33.2±2.6)U/ml,(88±4)U/L,(54±7)U/L,(294±11)U/L],which were higher than those in the non metastatic group[(14±6)kU/L,(17.0±1.6)ng/ml,(17.7±1.3)U/ml,(68.2±5.1)U/L,(17±4)U/L,(180±11)U/L](t=75.551,42.670,33.827,21.131,27.143,51.860,all P<0.05).The results of univariate analysis showed that the proportion of patients in the metastatic group with TNM staging of stageⅢ~Ⅳ,the depth of infiltration encroached on the plasma membrane layer,and the degree of tissue differentiation was low or moderately differentiated The percentage of patients(68.6%,71.4%,and 85.7%)increased compared to the non metastatic group(30.1%,24.7%,and 13.7%)(χ^(2)=14.292,21.597,and 52.614,all P<0.05).The results of multivariate logistic regression analysis showed that the risk factors for postoperative liver metastasis in colorectal cancer patients were TNM stage,CA19-9,AFP,CA50,ALP,GGT,and LDH(all P<0.05).The ROC curve analysis results show that the area under the curve(AUC)value of the combined detection of serum CA19-9,AFP,CA50,ALP,GGT,and LDH indicators was 0.887,which was higher than AUC value of the single detection of the above indicators.The sensitivity,specificity,and accuracy of the combined detection were 81.2%,87.3%,and 83.8%,respectively,which were higher than those of the single indicator detection.Conclusion There is a close relationship between serum levels of CA19-9,AFP,CA50,ALP,GGT,and LDH in patients with liver metastasis of colon cancer.The above indicators show an upward trend in colorectal cancer patients,and the combined detection of these indicators makes up for the shortcomings of single indicator detection,with high diagnostic value,which can provide reference for the development of clinical treatment plans for this disease.