血清CRP、CA19-9与CEA联合检测对结直肠癌的术前诊断价值

摘要

目的 探讨血清C反应蛋白(CRP)、糖链抗原19-9(CA19-9)与癌胚抗原(CEA)对结直肠癌的术前诊断价值.方法 选入150例结直肠癌患者,在入院后第2天进行CRP、CA19-9和CEA水平检测,与术后病理分期进行比较.建立CRP、CA19-9和CEA诊断II~IV期结直肠癌的ROC曲线,以进行诊断试验分析.结果 CRP、CA19-9和CEA在不同的病理TNM分期、T分期及M分期之间差异有统计学意义;CRP与CA19-9、CEA呈正相关(r=0.63和0.495,P均<0.01);CRP、CA19-9和CEA的ROC曲线下面积AZ分别为0.665(P=0.007),0.613(P=0.027),0.690(P=0.005);以血清CRP分界值为2.98mg·L-1时诊断II~IV期结直肠癌的敏感度为69.8%,特异度为64.7%;以CA19-9分界值为13.18U·mL-1时诊断II~IV期结直肠癌,其敏感度为66.4%,特异度为55.9%;以血清CEA分界值为5.84ng·mL-1时诊断II~IV期结直肠癌的敏感度为72.4%,特异度为58.8%.三项指标两两联合诊断的敏感度可分别提高至89.7%,91.3%,90.5%;CRP+CA19-9+CEA三项指标联合诊断的敏感度为96.6%,联合检测的敏感度高于单独检测(P<0.05).结论 血清CRP、CA19-9和CEA术前检测对评估结直肠癌的病理分期有一定的价值,联合检测有助于提升其诊断结直肠癌的敏感度,对辅助诊断结直肠癌有一定意义.%Objective To evaluate the clinical value of serum C-reactive protein(CRP),carbohydrate antigen CA19-9(CA19-9)and carcinoembryonic antigen(CEA)in patients with colorectal cancer.Methods150 patients with colorectal cancer were enrolled in this study. Serum CRP,CA19-9 and CEA levels were measured on the 2nd day after admission and compared with postoperative pathological staging. The ROC curve of CRP, CA19-9 and CEA diagnosing colorectal cancer from stage II to IV was established for diagnostic test. ResultsCRP,CA19-9 and CEA were statistically significant among different pathologic TNM staging,T stage and M staging. CRP was positively significantly correlated with CA19-9 and CEA(r=0.63 and 0.495,P<0.01). The area under the ROC curve of CRP,CA19-9 and CEA was 0.665(P=0.007),0.613(P=0.027),0.690(P=0.005). The sensitivity of diagnosis of colorectal cancer was 69.8% and the specificity was 64.7% when the serum CRP was 2.98mg·L-1. The sensitivity of the patients with colorectal cancer was 66.4% and the specificity was 55.9% when the threshold value of CA19-9 was 13.18U·mL-1. The sensitivity of colorectal cancer was 72.4% and the specificity was 58.8% when the serum CEA was 5.84ng·mL-1. The sensitivity of the three indicators of two joint diagnosiscan could be increased to 89.7%,91.3% and 90.5% respectively. The sensitivity of the combined test of CRP + CA19-9 + CEA was 96.6%,and the sensitivity of the combined detection was significantly higher than that of the individual assay(P<0.05).ConclusionSerum CRP,CA19-9 and CEA preoperative tests have a certain value in assessing the pathological stage of colorectal cancer. Combined detection can help to improve the sensitivity of colorectal cancer in diagnosis of colorectal cancer.