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[中性粒细胞与淋巴细胞比值、纤维蛋白原、癌胚抗原及糖类抗原19-9在结直肠癌中的价值]

[The value of NLR, FIB, CEA and CA19-9 in colorectal cancer].

作者信息

Qian X, Wang H, Ren Z, Jin F, Pan S Y

机构信息

Department of Laboratory Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Apr 6;55(4):499-505. doi: 10.3760/cma.j.cn112150-20200805-01094.

Abstract

To investigate the clinical value of neutrophil-lymphocyte ratio (NLR), fibrinogen (FIB), carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in the diagnosis and prognosis of colorectal cancer. A case-control study design was used to select 155 patients with colorectal cancer[98 males and 57 females, aged (63.12±13.99)years old], 90 patients with colorectal polyps[62 males and 28 females, aged (56.86±12.74)years old] and 150 healthy subjects[93 males and 57 females, aged (57.02±10.91)years old] from the First Affiliated Hospital of Nanjing Medical University from October 2017 to March 2018. Blood routine tests were detected by instrument method, FIB was detected by Clauss method, and CEA and CA19-9 were detected by electrochemiluminescence method. The levels of the NLR, FIB, CEA and CA19-9 in the 3 groups were compared. The diagnostic efficacy of NLR, FIB, CEA and CA19-9 of colorectal cancer was compared according to the ROC curve. The relationship between the level of NLR, FIB, CEA and CA19-9 and their clinicopathological features in colorectal cancer patients was assessed. According to the median levels of NLR, FIB, CEA and CA19-9, 112 follow-up of colorectal cancer patients could be divided into the high-value group and the low-value group. Kaplan-Meier, log-rank test and Cox regression analysis were used to analyze the relationship between the levels of the four indicators and the prognosis of colorectal cancer. The levels of NLR, FIB, CEA and CA19-9 in colorectal cancer group were 2.11(1.52, 2.86), 3.21(2.58, 3.86)g/L, 3.93(2.27, 8.78)μg/L, 15.11(9.10, 25.73)U/ml. The levels of NLR, FIB, CEA and CA19-9 in colorectal polyp group were 1.74(1.39, 2.17), 2.54(2.26, 3.03)g/L, 1.99(1.18, 2.70)μg/L, 9.83(6.13, 15.68)U/ml. The levels of NLR, FIB, CEA and CA19-9 in healthy control group were 1.68(1.33, 2.28), 2.56(2.30, 2.82)g/L, 1.85(1.28, 2.59)μg/L, 10.03(6.86, 13.26)U/ml. The levels of NLR, FIB, CEA and CA19-9 in colorectal cancer group were significantly higher than those in colorectal polyp group ( values were 3.568, 5.913, 6.880 and 4.022, values were all<0.05) and healthy control group( values were 3.916, 7.381, 9.131 and 5.251, values were all<0.05). The levels of NLR, FIB, CEA and CA19-9 in colorectal polyp group were not remarkably different from those in healthy control group ( values were 0.217, 0.179, 0.320 and 0.061, values were all>0.05). The diagnostic performance of CEA was the best in single test, followed by FIB, CA19-9 and NLR. The sensitivity of combined NLR+FIB+CEA or NLR+FIB+CEA+CA19-9 was the highest with 72.3%. NLR and FIB levels were associated with tumor sites ( values were 3.587 and 7.089, values were both<0.05). FIB and CEA levels were correlated with the depth of tumor invasion ( values were 3.250 and 3.245, values were both <0.05). NLR, FIB, CEA and CA19-9 levels were both associated with lymph node metastasis ( values were 2.010, 3.276, 3.312 and 2.921, values were all<0.05). The prognosis of patients in the high-value NLR, FIB, CEA and CA19-9 groups was significantly worse than that in the low-value group (χ values were 5.744, 6.048, 4.389 and 6.942, values were all<0.05).Cox multivariate regression analysis showed lymph node metastasis, NLR >2.15 and CA19-9 >15.47 U/ml are independent factors affecting the prognosis of colorectal cancer. NLR, FIB, CEA and CA19-9 can be applied in the auxiliary diagnosis and prognosis of colorectal cancer.

摘要

探讨中性粒细胞与淋巴细胞比值(NLR)、纤维蛋白原(FIB)、癌胚抗原(CEA)及糖类抗原19-9(CA19-9)在结直肠癌诊断及预后评估中的临床价值。采用病例对照研究设计,选取2017年10月至2018年3月期间于南京医科大学第一附属医院就诊的155例结直肠癌患者[男性98例,女性57例,年龄(63.12±13.99)岁]、90例结直肠息肉患者[男性62例,女性28例,年龄(56.86±12.74)岁]及150例健康体检者[男性93例,女性57例,年龄(57.02±10.91)岁]。血常规采用仪器法检测,FIB采用Clauss法检测,CEA及CA19-9采用电化学发光法检测。比较3组患者NLR、FIB、CEA及CA¬19-9水平;根据ROC曲线比较NLR、FIB、CEA及CA19-9对结直肠癌的诊断效能;评估结直肠癌患者NLR、FIB、CEA及CA19-9水平与临床病理特征的关系;根据NLR、FIB、CEA及CA19-9的中位数水平将112例结直肠癌患者分为高值组和低值组,采用Kaplan-Meier法、log-rank检验及Cox回归分析探讨上述4项指标水平与结直肠癌预后的关系。结直肠癌组NLR、FIB、CEA及CA19-9水平分别为2.11(1.52,2.86)、3.21(2.58,3.86)g/L、3.93(2.27,8.78)μg/L、15.11(9.10,25.73)U/ml;结直肠息肉组分别为1.74(1.39,2.17)、2.54(2.26,3.03)g/L、1.99(1.18,2.70)μg/L、9.83(6.13,15.68)U/ml;健康对照组分别为1.68(1.33,2.28)、2.56(2.30,2.82)g/L、1.85(1.28,2.59)μg/L、10.03(6.86,13.26)U/ml。结直肠癌组NLR、FIB、CEA及CA19-9水平均显著高于结直肠息肉组(值分别为3.568、5.913、6.880及4.022,均P<0.05)及健康对照组(值分别为3.916、7.381、9.131及5.251,均P<0.05)。结直肠息肉组NLR、FIB、CEA及CA19-9水平与健康对照组比较差异均无统计学意义(值分别为0.217、0.179、0.320及0.061,均P>0.05)。单项检测中CEA诊断效能最佳,其次为FIB、CA19-9及NLR。联合检测NLR+FIB+CEA或NLR+FIB+CEA+CA19-9时敏感度最高,为72.3%。NLR及FIB水平与肿瘤部位有关(值分别为3.587及7.089,均P<0.05);FIB及CEA水平与肿瘤浸润深度有关(值分别为3.250及3.245,均P<0.05);NLR、FIB、CEA及CA19-9水平均与淋巴结转移有关(值分别为2.010、3.276、3.312及2.921,均P<0.05)。NLR、FIB、CEA及CA19-9高值组患者预后显著差于低值组(χ值分别为5.744、6.048、4.389及6.942,均P<0.05)。Cox多因素回归分析显示,淋巴结转移、NLR>2.15及CA19-9>15.47 U/ml是影响结直肠癌预后的独立因素。NLR、FIB、CEA及CA19-9可用于结直肠癌的辅助诊断及预后评估。

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