摘要
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.
BACKGROUND At present,there is a lack of effective,non-invasive screening tests for colorectal precancerous lesions.Identification of high-risk groups and multi-biomarker detection have become the trend of cancer and precancerous lesion screening.Inflammatory markers have been widely used in the diagnosis and prognosis of various tumors,but there are few studies on their diagnostic value in precancerous lesions.AIM To explore the predictive value of the general characteristics,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),CEA,CA199,and immunochemical fecal occult blood testing(IFOBT)in the occurrence of advanced colorectal adenoma.METHODS Two hundred and ninety-five cases of advanced colorectal adenomas confirmed by pathology and electronic colonoscopy at our hospital from 2014 to 2018 were retrospectively analyzed,and 448 cases of nonadvanced adenomas in the same period were selected as a control group.The general clinical data of the patients,including basic characteristics(gender and age),living habits(smoking and drinking),and past history of disease(hypertension,coronary heart disease,diabetes),history of surgery(history of cholecystectomy or appendectomy),and laboratory examinations(NLR,PLR,CEA,CA199,and IFOBT)were collected.Measurement data were compared using t-test or Mann-Whitney U test,and count data were compared usingχ2 test.Statistically significant variables were included in binary logistic regression analysis.ROC curve was drawn to evaluate the predictive value of related indexes in the occurrence of advanced colorectal adenoma.RESULTS Multivariate logistic regression analysis demonstrated that age(odds ratio[OR]=1.047,95%confidence interval[CI]:1.028-1.066,P=0.000),smoking(OR=1.880,95%CI:1.250-2.826,P=0.002),diabetes(OR=2.073,95CI%:1.216-3.535,P=0.007),previous cholecystectomy(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),and NLR(OR=1.706,95%CI:1.388-2.097,P=0.000)were independent factors for advanced colorectal adenoma.ROC analysis showed that the areas under the ROC curves(AUCs)of IFOBT,CA199,and NLR in predicting advanced colorectal adenoma were 0.644(95%CI:0.602-0.686),0.639(95%CI:0.598-0.679),and 0.645(95%CI:0.605-0.685),respectively.The optimal cutoff values for NLR and CA199 were 2.04 and 7.87 U/mL,respectively.The sensitivity and specificity of IFOBT,CA199,and NLR in predicting advanced colorectal adenoma were 34.6%and 94.2%,53.9%and 66.1%,and 50.2%and 71.8%,respectively.The AUC of combination of the three biomarkers for the diagnosis of advanced adenoma was 0.752(95%CI:0.716-0.788),with a sensitivity of 52.9%and specificity of 82.8%.In the subgroup analysis,there were significant differences between the IFOBT(+)subgroup and IFOBT(-)subgroups with regard to tumor location(P=0.048),diameter(P=0.000),and differentiation(P=0.000).There were also significant differences between the low NLR(<2.04)subgroup and high NLR(≥2.04)subgroup with regard to gender(P=0.004),tumor diameter(P=0.028),and tumor differentiation(P=0.000).CONCLUSION Advanced colorectal adenoma is associated with advanced age,smoking,diabetes,and previous cholecystectomy,and more attention should be paid to populations with these risk factors.IFOBT,NLR,and CA199 have appreciated diagnostic value for advanced colorectal adenoma,with the combination of all three having the highest diagnostic value.
作者
王绪
张竞宇
郑忠青
王涛
朴美玉
刘恒
刘静
刘文天
Xu Wang;Jing-Yu Zhang;Zhong-Qing Zheng;Tao Wang;Mei-Yu Piao;Heng Liu;Jing Liu;Wen-Tian Liu(Department of Gastroenterology and Hepatology,Tianjin Medical University General Hospital,Tianjin 300052,China)
出处
《世界华人消化杂志》
CAS
2021年第7期347-355,共9页
World Chinese Journal of Digestology
基金
天津市科委慢性病防治科技重大专项,NO.17ZXMFSY00210.
