血清CEA、CA724、CA199水平及粪便FOBT、结直肠FH阳性对结直肠息肉病理分型的预测价值  

The predictive value of CEA,CA724,CA199,FOBT and colorectal epithelial FH in the pathological classification of colorectal polyps

作　　者：朱士法 乔敏 张帆 韩胜博 董方园 巩家慧 杨景玉 吴瑞丽 孔令斌 ZHU Shifa;QIAO Min;ZHANG Fan;HAN Shengbo;DONG Fangyuan;GONG Jiahui;YANG Jingyu;WU Ruili;KONG Lingbin(Clinical College,Jining Medical University,Jining 272067;Department of Intensive Care Medicine,Affiliated Hospital of Jining Medical University;Department of Gastroenterology,Affiliated Digestive Hospital of Shandong First Medical University,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272067 [2]济宁医学院附属医院重症医学科 [3]山东第一医科大学附属消化病医院消化内科

出　　处：《胃肠病学和肝病学杂志》2024年第5期552-557,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：山东省医药卫生科技发展计划项目(202003030503);济宁医学院科研创新团队(培育)项目—早期胃癌诊治团队(2022JNYXY22)。

摘　　要：目的比较不同结直肠息肉患者血清CEA、CA724、CA199水平及粪便FOBT、结直肠FH阳性,探讨以上指标对结直肠息肉病理分型的预测价值。方法选取就诊于山东第一医科大学附属消化病医院的结直肠息肉患者235例,根据病理结果分为非肿瘤性息肉组、管状腺瘤伴低级别上皮内瘤变组、管状腺瘤伴高级别上皮内瘤变组。比较不同组别患者血清CEA、CA724、CA199水平及粪便FOBT、结直肠FH阳性率。将差异有显著性的指标进一步采用多因素非条件Logistic回归分析,建立回归方程,计算各项指标对管状腺瘤性息肉高级别上皮内瘤变的最佳截断值。结果非肿瘤性息肉组、管状腺瘤伴低级别上皮内瘤变组、管状腺瘤伴高级别上皮内瘤变组患者血清CEA、CA724、CA199水平及粪便FOBT、结直肠FH阳性率依次升高。与管状腺瘤性息肉高级别上皮内瘤变相关的因素有息肉数量、FOBT、FH,联合检测判断管状腺瘤性息肉高级别上皮内瘤变的AUC为0.754(95%CI:0.656~0.851,P<0.05),最佳截断值为0.346,敏感度为77.7%,特异度为64.0%,最大约登指数为0.411。结论血清CEA、CA724、CA199水平及粪便FOBT、结直肠FH阳性对结直肠息肉的病理分型具有一定的筛查价值。息肉多发、FOBT及FH阳性可能是预测管状腺瘤性息肉上皮内瘤变程度的早期预测因素。Objective To compare the serum CEA,CA724,CA199 levels and fecal FOBT,as well as colorectal FH positivity in patients with different colorectal polyps,and to explore the predictive value of these indexes for the pathological classification of colorectal polyps.Methods A total of 235 patients with colorectal polyps in the Affiliated Digestive Hospital of Shandong First Medical University were selected and categorized into non-neoplastic polyps group,tubular adenoma with low-grade intraepithelial neoplasia group and tubular adenoma with high-grade intraepithelial neoplasia group based on pathological results.Serum CEA,CA724,CA199 levels,fecal FOBT,colorectal FH positive rates were compared in different groups.Multivariate Logistic regression analysis was further used to establish regression equations for the indicators with significant differences,and the optimal cut-off values for each index for high-grade intraepithelial neoplasia of tubular adenomatous polyps were calculated.Results The levels of serum CEA,CA724,CA199,fecal FOBT and colorectal FH in non-neoplastic polyp group,tubular adenoma with low-grade intraepithelial neoplasia group,tubular adenoma with high-grade intraepithelial neoplasia group were increased successively.The factors related to the high-grade intraepithelial neoplasia of tubular adenomatous polyps included the number of polyps,FOBT and FH.The AUC of the high-grade intraepithelial neoplasia of tubular adenomatous polyps was 0.754(95%CI:0.656-0.851,P<0.05),the best cut-off value was 0.346,with a sensitivity of 77.7%,specificity of 64.0%,and maximum Youden index of 0.411.Conclusion Serum CEA,CA724,CA199 levels,fecal FOBT and colorectal FH positivity have certain screening value for the pathological types of colorectal polyps.Multiple polyps,positive FOBT and FH may serve as early predictors of intraepithelial neoplasia of tubular adenomatous polyps.

关 键 词：结直肠息肉 FH FOBT CEA CA724 CA199 病理分型 

分 类 号：R574[医药卫生—消化系统]