2018 年第 11 期 第 13 卷

胃癌患者血常规和血生化指标的变化及相关肿瘤标志物在胃癌诊断中的价值

Diagnostic values of blood routine, blood biochemical indicators and tumor markers in gastric cancer

作者：张璐璐刘芸段文冰唐闻李晓莹赵万辉许瑞

英文作者：

单位：250021济南，山东大学附属省立医院临床医学检验部

英文单位：

关键词：胃癌；糖类抗原；中性粒细胞与淋巴细胞比值

英文关键词：

• 摘要：

• 【摘要】目的    分别探讨胃癌患者部分血常规和血生化指标的变化及相关肿瘤标志物在胃癌诊断中的价值。方法    选取2016年2月至2017年2月于山东大学附属省立医院首诊的经病理检查确诊的胃癌患者76例作为胃癌组，胃良性病变患者46例作为胃良性病变组，健康查体的39名健康志愿者作为健康对照组。检测3组研究对象肿瘤标志物癌胚抗原、糖类抗原125、糖类抗原199、糖类抗原724的含量；同时对胃癌组及健康对照组患者进行血常规、唾液酸、前白蛋白、超氧化物歧化酶（SOD）、糖化血清白蛋白、补体C1q、血脂等相关指标检测，并对结果进行统计分析。结果    ①胃癌组红细胞体积分布宽度(RDW)、中性粒细胞计数（NEU）、NEU与淋巴细胞计数（LYM）的比值（NLR）、唾液酸均高于健康对照组，红细胞压积、LYM、前白蛋白、SOD、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇均低于健康对照组，差异均有统计学意义（均P<0.05）。胃癌组有淋巴转移患者RDW、NLR、前白蛋白高于无淋巴结转移患者，LYM低于无淋巴结转移患者，差异均有统计学意义（均P<0.05）。②4项肿瘤标志物中单项检测中糖类抗原724阳性率最高；但4项联合检测的阳性率明显高于癌胚抗原、糖类抗原125、糖类抗原199、糖类抗原724任何单项检测的阳性率［51.3%（39/76）比15.7%（12/76）、21.0%（19/76）、25.0%（19/76）、27.6%（21/76）］，差异均有统计学意义（均P<0.05）。4项肿瘤标志物指标联合检测的敏感度为51.31%，特异度为92.30%，准确度65.21%，阳性预测值为92.85%，阴性预测值为49.31%，其中除了特异度和阳性预测值较（部分）单项指标略有所下降，其他各项指标均高于单项检测。癌胚抗原、糖类抗原125、糖类抗原199、糖类抗原724的受试者工作特征（ROC）曲线下面积分别是0.559、0.598、0.742、0.743，联合检测的ROC曲线下面积为0.902。血清中糖类抗原199、糖类抗原724的含量在胃癌患者有无淋巴结转移类别间差异有统计学意义（P＜0.05）。结论    胃癌患者诸多生化指标水平明显异常，RDW、NLR、前白蛋白对胃癌转移的诊断有着重要的参考价值。癌胚抗原、糖类抗原125、糖类抗原199、糖类抗原724联合检测可大大提高胃癌早期诊断效能，有助于胃癌与胃良性病变的鉴别诊断。

• 【Abstract】Objective    To investigate the values of blood routine, blood biochemical indicators and tumor markers in the diagnosis of gastric cancer. Methods    From February 2016 to February 2017, 76 patients with gastric cancer, 46 patients with benign gastric disease and 39 healthy volunteers were enrolled in Shandong Provincial Hospital Affiliated to Shandong University. Carcinoembryonic antigen(CEA), carbohydrate antigen(CA)125, CA199, CA724, blood routine, sialic acid, prealbumin, superoxide dismutase(SOD), glycosylated serum protein, complement C1q and blood lipid were tested. Results    Red blood cell volume distribution width(RDW), neutrophil count(NEU), the ratio of NEU to lymphocyte count(LYM)(NLR) and sialic acid in gastric cancer patients were higher than those in healthy people; hematocrit, LYM, prealbumin, SOD, high density lipoprotein cholesterol and low density lipoprotein cholesterol in gastric cancer patients were lower than those in healthy people(P<0.05). RDW, NLR, prealbumin in gastric cancer patients with lymphatic metastasis were higher and LYM was lower than those in patients without lymphatic metastasis(P<0.05). The positive rate of CA724 was the highest in the single detection of 4 tumor markers; the positive rate of joint detection of CEA, CA125, CA199 and CA724 was significantly higher than that of the single detection［51.3%（39/76） vs 15.7%（12/76）, 21.0%（19/76）, 25.0%（19/76）, 27.6%(21/76)］（P<0.05）. The sensitivity of joint detection of 4 tumor markers was 51.31%; the specificity was 92.30%; the accuracy was 65.21%; the positive predictive value was 92.85%; the negative predictive value was 49.31%. The area under receiver operating characteristic（ROC） curve of CEA, CA125, CA199 and CA724 was 0.559, 0.598, 0.742 and 0.743; the area under ROC curve of joint detection of 4 tumor markers was 0.902. There were significant differences of serum CA199 and CA724 levels between gastric cancer patients with and without lymphatic metastasis(P<0.05). Conclusion    sRDW, NLR and prealbumin have good auxiliary diagnostic values for gastric cancer and lymphatic metastasis. Combined detection of CEA, CA125, CA199 and CA724 can improve the early diagnostic efficiency of gastric cancer and help to differentiate gastric cancer and benign lesion.