胃癌患者手术前后外周血D-二聚体与CA724水平测定及意义

Determination of peripheral blood D-dimmer and CA724 levels for patients with gastric cancer before and after surgery and its clinical significance

目的测定胃癌患者手术前后外周血中D二聚体(D-D)、糖类抗原724(CA724)表达水平,并探讨其临床意义。方法选择2014年1月至2015年3月在我院胃肠外科接受治疗的56例胃癌患者作为胃癌组,另选取56例胃良性病变患者和56例健康体检者分别纳入胃良性病变组及健康对照组。比较各组受检者的D-D及CA724水平,分析胃癌患者病理指标与D-D及CA724水平的关系,以及影响胃癌患者D-D及CA724水平升高的相关因素。结果治疗前,胃癌组及胃良性病变组患者的D-D及CA724水平均明显高于健康对照组,且胃癌组患者的D-D及CA724水平明显高于胃良性病变组,差异均有统计学意义(P<0.05);治疗后,胃癌组患者的D-D及CA724水平仍明显高于健康对照组,差异均有统计学意义(P<0.05),而胃良性病变组患者的D-D及CA724水平与健康对照组相比,差异均无统计学意义(P>0.05);胃癌浆膜层浸润的患者D-D及CA724水平均明显高于固有层及肌层浸润者,有淋巴结转移的患者D-D及CA724水平均明显高于无淋巴结转移者,低分化者D-D及CA724水平均明显高于中、高分化者,差异均有统计学意义(P<0.05);将胃癌患者D-D及CA724水平升高作为因变量,将浆膜层浸润和有淋巴结转移,以及低分化作为自变量,实施Logistic回归分析发现,浆膜层浸润和有淋巴结转移,以及低分化均为胃癌患者D-D及CA724水平升高的相关因素(P<0.05)。CA724以6.90 U/m L为临界值时,单独CA724监测胃癌的敏感度、准确度均为83.93%,D-D以0.50 mg/L为临界值时,单独CA724监测胃癌的敏感度、准确度均为82.21%,当D-D及CA724联合监测时,其敏感度及准确度均为96.43%(54/56),提示D-D及CA724联合监测对于胃癌的诊断价值明显高于单独D-D及CA724监测,差异有统计学意义(χ2单独D-D=5.973,χ2单独CA724=4.940,均P<0.05)。结论胃癌患者手术前后监测外周血D-D及CA724指标水平可较好地反映其疾病情况,值得临床推荐。

Objective To study the expression level of D-dimer(D-D) and carbohydrate antigen 724(CA724)before and after surgery and its clinical significance in peripheral blood of patients with gastric cancer. Methods Fifty-six patients of gastric cancer from January 2014 to March 2015 treated in our hospital were selected as the research subjects(gastric cancer group). Another 56 patients with benign gastric disease and 56 healthy subjects were included in the benign gastric disease group and healthy control group. D-D and CA724 level were compared between the three groups, and the relationship between pathological indexes of gastric cancer and D-D and CA724 levels were analyzed.The related factors of elevated D-D and CA724 levels in patients with gastric cancer were also analyzed. Results Before treatment, D-D and CA724 levels in gastric cancer group and benign gastric disease group were significantly higher than those in healthy control group, and the D-D and CA724 levels in gastric cancer group were significantly higher than those in benign gastric disease group(P<0.05). After treatment, D-D and CA724 levels in gastric cancer group were significantly higher than those in healthy control group(P<0.05), while D-D and CA724 levels in benign gastric disease group showed no significant difference with those in health control group(P>0.05). D-D and CA724 levels in gastric cancer patients with serosa infiltration were significantly higher than those in patients with stroma and myometrial invasion, and the levels were also significantly higher in patients with lymph node metastasis than patients without lymph node metastasis and in patients with poor differentiation than patients with medium or high differentiation(all P<0.05).Taking elevated D-D and CA724 levels in gastric cancer patients as the dependent variable and the serosa invasion,lymph node metastasis, low differentiation as the independent variable, logistic regression analysis showed serosa invasion and lymph node metastasis, and low differentiation were the related factors of elevated D-D and CA724 levels in patients with gastric carcinoma differentiation(P<0.05). The sensitivity and accuracy of gastric cancer was 83.93%,83.93% for CA724 alone(with CA724 of 6.90 U/m L as the critical value,) and 82.21%, 82.21% for D-D alone(with0.50 mg/L as the critical value). For combined detection of D-D and CA724, the sensitivity and accuracy were 96.43%(54/56), 96.43%(54/56), which were significantly higher than those for D-D or CA724 alone(χ2D-D alone=5.973,χ2CA724 alone=4.940, P<0.05). Conclusion Monitoring of D-D and CA724 index in peripheral blood of patients with gastric carcinoma can reflect the disease situation, which is worthy of recommendation.