Value of combined detection of IFOBT,tumor markers,and inflammatory markers in predicting occurrence of advanced colorectal adenoma
- Author:
- No author available
- Journal Title:
- World Chinese Journal of Digestology
- Issue:
- 7
- DOI:
- 10.11569/wcjd.v29.i7.347
- Key Word:
- 进展期腺瘤;结直肠腺瘤;中性粒细胞/淋巴细胞比值;CA199;粪便免疫潜血实验;预测价值
Abstract： 背景 目前临床缺乏对结直肠癌前病变有效的无创筛查手段,识别高危人群和多指标联合检测已成为癌及癌前病变筛查的趋势.多种炎症指标已广泛用于各种肿瘤的诊断及预后,而对癌前病变诊断价值的研究较少.目的 探讨粪便免疫潜血实验(immunochemical fecal occult blood testing,IFOBT),肿瘤标志物(CEA、CA199),炎症指标包括中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)及一般临床特征对结直肠进展期腺瘤息肉发生的预测价值.方法 回顾性分析我院2014-2018年行电子结肠镜检查并经病理学证实的295例结直肠进展期腺瘤病例作为观察组,选择同期448例非进展期腺瘤病例作为对照组,收集患者的一般临床资料包括基本特征(性别、年龄)、生活习惯(吸烟史、饮酒史)、既往史(高血压史、冠心病史、糖尿病史),手术史(胆囊或阑尾切除史);实验室检查(NLR、PLR、CEA、CA199、IFOBT);进行单因素差异分析,将有意义的结果纳入二元logistic回归分析,绘制ROC曲线,评估相关指标对结直肠进展期腺瘤发生的预测价值.结果 Logistic回归分析显示:年龄(OR = 1.047,95％CI:1.028-1.066,P = 0.000)、吸烟(OR = 1.880,95％CI:1.250-2.826,P= 0.002)、糖尿病(OR = 2.073,95CI％:1.216-3.535,P= 0.007)、既往胆囊切除(OR = 9.206,95CI％:2.904-29.181,P= 0.000)、IFOBT(OR = 7.681,95％CI:4.585-12.869,P= 0.000)、CA199(OR= 1.039,95％CI:1.018-1.059,P= 0.000)、NLR(OR = 1.706,95％CI:1.388-2.097,P= 0.000)与进展期腺瘤的发生独立相关.对于预测进展期腺瘤的发生,IFOBT的灵敏度为34.6％,特异度为94.2％,AUC为0.644,95％CI:0.602-0.686,CA199的最佳截断点为7.87 U/mL,灵敏度为53.9％,特异度为66.1％,AUC为0.639,95％CI:0.598-0.679,NLR的最佳截断点为2.04,灵敏度为50.2％.特异度为71.8％,AUC为0.645,95％CI:0.605-0.685,当三者联合检测时其灵敏度为52.9％,特异度为82.8％,AUC 95％CI为0.752(0.716-0.788),进展期腺瘤亚组分析中,IFOBT(-)和IFOBT(+)亚组之间的腺瘤位置(P = 0.048)、腺瘤直径(P= 0.000)、分化级别(P = 0.000)差异有统计学意义,低NLR(＜2.04)和高NLR(≥2.04)亚组之间的性别(P= 0.004)、腺瘤直径(P= 0.028)、分化级别(P = 0.000)差异有统计学意义.结论 高龄、吸烟、糖尿病、既往胆囊切除人群更易发生结直肠进展期腺瘤,临床需对此类人群提高重视,IFOBT、NLR、CA199对进展期腺瘤的发生具有诊断意义,三者联合检测时其诊断效能最佳.
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