血清CA 199、C3、C4及脂类代谢水平在胰腺癌临床诊断中的应用

摘要

目的：评估单独及联合检测血清CA199、补体3（C3）、补体4（C4）、总胆固醇（TC）和脂类代谢水平在胰腺癌临床诊断中的应用价值，并探讨上述指标与胰腺癌 TNM 分期及病理分期的关系。方法：收集77例胰腺癌患者（Pc组）、58例非消化系统肿瘤患者（Ndc组）和50名健康对照者（Hc组）共185例血清，测定各组受试者血清CA199、C3、C4以及甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白 A （ApoA）、载脂蛋白B （ApoB）、载脂蛋白 E （ApoE）和脂蛋白 a [Lp （a）]等脂代谢水平，并对结果进行统计分析。结果：①Pc组患者血清 CA199水平显著高于 Ndc组和 Hc组（P＜0.01），而 Ndc组与 Hc组比较差异无统计学意义（P＞0.05）；Pc组和 Ndc组患者血清 C3、C4及 ApoE水平显著高于Hc组（P＜0.01），且Pc组显著高于 Ndc组（P＜0.01）；Pc组患者血清 HDL-C、ApoA和 Lp （a）水平低于Ndc组和 Hc组（P＜0.05）。②Pc组患者血清 CA199、C3、C4、ApoE、HDL-C、ApoA受试者工作特征曲线（ROC）下面积（AUC）分别为0.916、0.841、0.788、0.785、0.834和0.810，对胰腺癌均具有一定诊断价值；多因素联合分析，联合检测血清CA199、C3和 HDL-C （AUC＝0.968）较单独检测CA199具有更高的诊断价值（P＜0.05）。③TNM分期，Ⅲ-Ⅳ期胰腺癌患者血清CA199水平显著高于Ⅰ-Ⅱ期患者（P＜0.01）；而病理分期中高分化组患者血清 ApoA水平明显低于低分化组患者（P＜0.05），其他指标比较差异无统计学意义（P＞0.05）。结论：胰腺癌患者血清CA199、C3、C4及ApoE水平明显升高，而 HDL-C、ApoA以及Lp （a）水平明显降低；在胰腺癌早期诊断中，联合检测血清CA199、C3和 HDL-C优于各指标单项评估。%Objective:To evaluate the diagnostic values of single and combined detection of serum CA199, complement 3 (C3),complement 4 (C4),total cholesterol (TC),triglyceride (TG),and lipid metabolism levels in the patients with pancreatic cancer, and to explore their correlations with TNM stage and pathological stage of pancreatic cancer.Methods:Total 185 subjects were enrolled into the study by three groups:pancreatic cancer patients group (Pc group,n=77),non-digestive system cancer patients group (Ndc group,n=58)and healthy control group (Hc group,n=50).The levels of serum CA199,C3,C4,and high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A (ApoA), apolipoprotein B (ApoB), apolipoprotein E (ApoE),and lipoprotein a (Lpa)levels were detected.Results:① The serum level of CA199, C3,C4,and ApoE of the patients in Pc group were higher than those in Ndc and Hc groups (P<0.01).No statistical difference was observed in the serum CA199 between Ndc and Hc groups (P>0.05).The levels of C3, C4,and ApoE in Pc group and Ndc group was higher than those in Hc group (P<0.01),and the levels of the biomarkers in Pc group were also higher than those in Ndc group (P<0.01).The levels of HDL-C,ApoA and Lp (a)of the patients in Pc group were significantly lower than those in Ndc and Hc groups (P<0.05).② The area under ROC curve (AUC)of serum CA199,C3,C4,ApoE,HDL-C,and ApoA were 0.916,0.841, 0.788,0.785,0.834,and 0.810,respectively.Furthermore,multiple factor analysis showed that the combined detection of CA199,C3,and HDL-C (AUC=0.968)improved the diagnosis compared with detecting CA199 alone (P<0.05).③ The CA199 level of the patients inⅢ-Ⅳ stage of TNM stage was higher than that in the patients inⅠ-Ⅱ stage (P<0.01).For the pathological stage,the ApoA level in low differentiation group was higher than that in moderate and high differentiation group (P<0.05).There was no statistical difference in other biomarkers between the different TNM stages and pathological stages.Conclusion:The levels of CA199,C3,C4 and ApoE of pancreatic cancer patients are significantly increased, while the levels of HDL-C, ApoA, and Lp (a ) are significantly reduced.Combined detection of CA199,C3,and HDL-C can improve the early diagnosis of pancreatic cancer compared with the single assessment of each biomarker.