胃肠道恶性肿瘤患者血浆D二聚体和脂蛋白浓度变化及临床意义

Significance of plasma D-dimer and lipoproteins level in patients with gastrointestinal cancer

目的 探讨血浆D二聚体、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白a[LP(a)]浓度变化在胃肠道恶性肿瘤中的临床价值.方法 选择胃肠道恶性肿瘤患者139例和健康体检者155名,采用胶乳增强免疫比浊法测定D二聚体浓度,直接法测定血清HDL-C、LDL-C、LP(a)浓度,化学发光法测定血清癌胚抗原浓度,分析各指标在胃肠道恶性肿瘤和健康体检者中的差异,确定各指标在胃肠道恶性肿瘤中的敏感性和特异性,探讨其浓度与淋巴结转移及远处转移的关系.结果 与健康体检者相比,胃肠道恶性肿瘤患者的血浆D二聚体[0.80(2.37) mg/L与0.21 (0.22)mg/L]、LDL-C[3.46 (1.46) mmol/L与2.86(0.98) mmol/L]、LP(a)[317(262) mg/L与139(187) g/L]、CEA[2.61(3.62) μg/L与1.29(1.42) μg/L]浓度明显升高(Z值分别为-8.388、-6.150、-8.589、-7.142,P均＜0.001),HDL-C分别为[0.86(0.38) mmol/L与1.29 (1.42) mmol/L],浓度明显降低(Z=-10.643,P＜0.001).D二聚体、HDL-C、LDL-C、LP(a)、癌胚抗原(CEA)的ROC曲线下面积分别为0.783、0.859、0.708、0.790,0.741.D二聚体、LDL-C、LP(a)曲线下面积与CEA比较,差异无统计学意义(Z值分别为1.110、0.809、1.257,P值分别为0.27,0.42,0.21).HDL-C曲线下面积与CEA相比,差异具有统计学意义(Z=3.225,P=0.0013).与无淋巴结转移患者相比,有淋巴结转移患者的血浆D二聚体、LDL-C、LP(a)浓度明显升高(P值分别为0.003,0.002,0.005),HDL-C浓度明显降低(P=0.001);与无远处转移患者相比,远处转移患者的血清D二聚体、LDL-C、LP(a)浓度明显升高(P均＜0.001),HDL-C浓度明显降低(P ＜0.001).结论 D二聚体和脂蛋白可为胃肠道恶性肿瘤的诊断和病情评估提供一定的依据.

Objective To investigate the significance of plasma D-dimers,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol (LDL-C) and apolipoprotein a (LP (a)) of patients with gastrointestinal cancer.Methods One hundred and thirty-nine cases with gastrointestinal cancer and 155 healthy persons were selected as subjects.Latex enhanced immunoassays method was used to measure the D dimer concentration.Direct method was applied to detect the levels of serum HDL-C,LDL-C,LP (a)Chemiluminescence method was applied to detect serum carcinoembryonic antigen (CEA)concentration.Determine the sensitivity and specificity of each index in gastrointestinal cancer,and explore the relationship between the concentration and the lymph node metastasis and distant metastasis.Results The levels of D-dimer,LDL-C,LP (a),CEA in patients with gastrointestinal carcinoma were 0.80 (2.37) mg/L,3.46 (1.46) mmol/L,317 (262) mg/L,2.61 (3.62) μ,g/L respectively,significant higher than those of health control(0.21 (0.22) mg/L,2.86 (0.98) mtmol/L,139 (187) g/L,1.29 (1.42) μg/L respectively; Z =-8.388,-6.150,-8.589,-7.142,P ＜0.001).The level of HDL-C in gastrointestinal cancer patients was 0.86(0.38) mmoL/L,lower than that of health control(1.29(1.42) mmol/L; Z =-10.643,P ＜0.001)The area of ROC curve of D-dimmer,HDL-C,LDL-C,LP (a),CEA were 0.783,0.859,0.708,0.790,0.741 respectively.Compared with area of ROC curve of CEA,that of D-dimer,LDL-C,LP(a) were significant different (Z =1.110,0.809,1.257 ; P =0.27,0.42,0.21).Compared with CEA AUC,HDL-C AUC was significant different (Z =3.225,P =0.0013).Compared with patients with no lymph node metastasis,the levels of D-dimers,LDL-C,LP (a) in patients with lymph node metastasis were higher (P =0.003,0.002,0.005 respectively).And the concentration of HDL-C decreased significantly (P =0.001).Compared with patients without metastases,serum D-dimer,LDL-CLP (a) concentration in patients with distant metastasis were significant higher(P ＜ 0.001) and the concentration of HDL-C decreased (P ＜ 0.001).Conclusion The levels of D-dimer and lipoprotein might be proved the base for diagnosis or assessment of gastrointestinal malignant tumor.