CTC联合血清NSE、CEA、CA153检测在结肠癌定性诊断及分期中的应用  

Application of CTC combined with serum NSE,CEA and CA153 detection in qualitative diagnosis and staging of colon cancer

作　　者：李芳奇 台卫平[1] 赵书博 Li Fangqi;Tai Weiping;Zhao Shubo(Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院消化内科,北京100038

出　　处：《保健医学研究与实践》2023年第11期46-51,共6页Health Medicine Research and Practice

基　　金：首都卫生发展科研专项课题(首发2020-4-2085)。

摘　　要：目的探讨CT结肠成像(CTC)联合血清神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、糖类抗原153(CA153)检测在结肠癌定性诊断及分期中的应用价值。方法回顾性分析2021年2月—2022年8月首都医科大学附属北京世纪坛医院收治的130例疑似结肠癌患者的临床资料。患者均行低剂量CTC结合增强扫描、血清NSE、CEA、CA153水平检测及结肠镜检查,根据结肠镜检查结果分为良性病变组和结肠癌组,比较2组患者血清肿瘤标志物水平,并以结肠镜检查结果为金标准,分析比较CTC检查、血清肿瘤标志物检测及二者联合检查对结肠癌定性诊断及分期的诊断效能。结果经结肠镜检查证实,130例患者中有84例(64.62%)为良性病变,46例(35.38%)为结肠癌;结肠癌组患者血清NSE、CEA、CA153水平均高于良性病变组,差异均有统计学意义(P<0.05)。CTC检查联合血清肿瘤标志物检测对结肠癌定性诊断的灵敏度、特异度、准确度均高于单一检查,漏诊率和误诊率均低于单一检查,差异均有统计学意义(P<0.05);且Kappa检验结果显示,二者联合检查对结肠癌定性诊断的一致性高(Kappa值为0.885)。46例结肠癌患者中,Ⅰ期13例,Ⅱ期14例,Ⅲ期15例,Ⅳ期4例;CTC检查联合血清肿瘤标志物检测对诊断结肠癌不同分期的总准确率为82.61%(38/46),高于CTC检查的56.52%(26/46)和血清肿瘤标志物检测的65.22%(30/46),差异均有统计学意义(χ^(2)=7.393、4.449,P=0.007、0.035);且Kappa检验结果显示,二者联合检查对结肠癌Ⅰ~Ⅲ期诊断的一致性较高(Kappa值为0.835、0.661、0.795),对Ⅳ期诊断的一致性高(Kappa值为0.846)。ROC曲线分析结果显示,血清NSE、CEA、CA153检测诊断结肠癌的曲线下面积(AUC)值分别为0.613、0.866、0.686,CTC联合NSE、CEA、CA153检测诊断的AUC值为0.916,联合检测诊断价值更高。结论CTC检查联合血清NSE、CEA、CA153检测能更好地反映结肠癌疾病严重程度,有助于结肠癌Objective To investigate the value of CT colonography(CTC)combined with serum neuron-specific enolase(NSE),carcinoembryonic antigen(CEA),and carbohydrate antigen 153(CA153)in the qualitative diagnosis and staging of colon cancer.Methods The clinical data of 130 patients with suspected colon cancer admitted to Beijing Shijitan Hospital,Capital Medical University from February 2021 to August 2022 were analyzed retrospectively.Patients underwent low-dose CTC combined with enhanced scan,serum NSE,CEA,CA153 levels,and colonoscopy.According to the results of the colonoscopy,patients were assigned to the benign lesion group and colon cancer group.The levels of serum tumor markers were compared between the two groups.The diagnostic efficacy of CTC examination,serum tumor marker detection,and their combination in the qualitative diagnosis and staging of colon cancer were analyzed and compared using the results of colonoscopy as the gold standard.Results Colonoscopy confirmed that 84(64.62%)of 130 patients had benign lesions and 46(35.38%)had colon cancer;the serum NSE,CEA,and CA153 levels in the colon cancer group were significantly higher than those in the benign lesions group(P<0.05).The sensitivity,specificity,and accuracy of CTC examination combined with serum tumor marker detection in the qualitative diagnosis of colon cancer were significantly higher than those of single examination,and the missed diagnosis rate and misdiagnosis rate were significantly lower than those of single examination(P<0.05).The results of the Kappa test showed that the combined examination of the two had a high agreement in the qualitative diagnosis of colon cancer(Kappa value=0.885).Of the 46 patients with colon cancer,13 were in stage Ⅰ,14 in stage Ⅱ,15 in stage Ⅲ,and 4 in stage Ⅳ;the overall accuracy of CTC examination combined with serum tumor marker detection for the diagnosis of different stages of colon cancer was 82.61%(38/46),which was higher than 56.52%(26/46)of CTC examination and 65.22%(30/46)of serum tumor marker detecti

关 键 词：CT结肠成像 神经元特异性烯醇化酶 癌胚抗原 糖类抗原153 结肠癌 定性诊断 

分 类 号：R735.3[医药卫生—肿瘤]