2024 年第 4 期 第 19 卷

外周血相关指标在结肠癌和结肠腺瘤鉴别诊断中的临床价值研究

The clinical value of peripheral blood related indicators in the differential diagnosis of colon cancer and colon adenoma

作者：赵士玉1鞠瑛1高斌斌2田文君1卢冰如1丁山1刘义庆1

英文作者：Zhao Shiyu1 Ju Ying1 Gao Binbin2 Tian Wenjun1 Lu Bingru1 Ding Shan1 Liu Yiqing1

单位：1山东第一医科大学附属省立医院临床医学检验部，济南250021；2山东第一医科大学附属省立医院肿瘤微创综合治疗科，济南250021

英文单位：1Department of Clinical Laboratory Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan 250021 China; 2Department of Tumor Minimally Invasive Comprehensive Treatment Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan 250021 China

关键词：结肠癌；结肠腺瘤；中性粒细胞与白细胞比值；淋巴细胞与白细胞比值；联合检测

英文关键词：Coloncancer;Colonadenoma;Neutrophiltowhitebloodcellratio;Lymphocytetowhitebloodcellratio;Combineddetection

• 摘要：

• 目的 探讨外周血中性粒细胞与白细胞比值(NWR)、淋巴细胞与白细胞比值(LWR)、癌胚抗原、糖类抗原125(CA125)在结肠癌和结肠腺瘤鉴别诊断中的临床价值。方法 收集2015年4月至2022年8月于山东第一医科大学附属省立医院确诊为结肠癌并行结肠癌根治术的129例结肠癌患者作为结肠癌组，随机收集同期结肠腺瘤患者129例作为结肠腺瘤组，回顾性分析比较2组患者的临床资料和外周血NWR、LWR、癌胚抗原、CA125水平，分析外周血4项指标与结肠癌病理特征的关系；绘制受试者工作特征(ROC)曲线，分析NWR、LWR、癌胚抗原、CA125单独及联合检测在结肠癌和结肠腺瘤鉴别诊断中的临床价值。结果 结肠癌组NWR、癌胚抗原、CA125水平均高于结肠腺瘤组，LWR低于结肠腺瘤组，差异均有统计学意义（均P<0.05）。浸润深度超过肌层的结肠癌患者癌胚抗原高于未超过肌层的患者，肿瘤直径≥7 cm患者外周血LMR低于肿瘤直径＜7 cm的患者，而NWR、CA125水平高于肿瘤直径＜7 cm的患者，差异均有统计学意义（均P＜0.05）。ROC曲线分析结果显示，与单独检测［NWR曲线下面积（AUC）=0.746,95%置信区间：0.707～0.814；LWR AUC=0.739,95%置信区间：0.681～0.792；癌胚抗原AUC=0.572,95%置信区间：0.509～0.633；CA125 AUC=0.635,95%置信区间：0.573～0.694］相比，NWR、LWR、癌胚抗原和CA125联合检测可以提高对结肠癌与结肠腺瘤患者鉴别诊断的效能(AUC=0.799,95%置信区间：0.745～0.846)。结论 NWR、LWR、癌胚抗原和CA125联合检测对鉴别诊断结肠癌与结肠腺瘤患者具有一定的预测价值，可以辅助结肠癌诊断。

• Objective To investigate the clinical value of peripheral blood neutrophil to white blood cell ratio(NWR), lymphocyte to white blood cell ratio(LWR), carcinoembryonic antigen(CEA), and carbohydrate antigen 125(CA125) in the differential diagnosis of colon cancer and colon adenoma. Methods A total of 129 colon cancer patients who were diagnosed with colon cancer and underwent radical colon cancer surgery at Shandong Provincial Hospital Affiliated to Shandong First Medical University from April 2015 to August 2022 were collected as the colon cancer group. During the same period, 129 colon adenoma patients were randomly collected as the colon adenoma group for retrospective analysis. The clinical data and peripheral blood NWR, LWR, CEA and CA125 levels were compared between the two groups. The relationship between four peripheral blood indicators and the pathological characteristics of colon cancer was analyzed. The receiver operating characteristic (ROC) curve was drawn to analyze the clinical value of NWR, LWR, CEA, CA125 alone and combined detection in the differential diagnosis of colon cancer and colon adenoma. Results The levels of NWR, CEA and CA125 in colon cancer group were higher than those in colon adenoma group, and LWR was lower than that in colon adenoma group(all P<0.05). The CEA of colon cancer patients with invasion depth beyond the muscular layer was higher than that of patients without invasion depth beyond the muscular layer, the LMR of peripheral blood of patients with tumor diameter ≥7 cm was lower than that of patients with tumor diameter < 7 cm, while NWR and CA125 levels were higher than those of patients with tumor diameter < 7 cm(all P<0.05). The results of ROC curve analysis showed that the combined detection of NWR, LWR, CEA and CA125 ［area under the curve(AUC)=0.799, 95% confidence interval: 0.745-0.846］ could improve the efficacy of differential diagnosis of colon cancer and colon adenoma patients compared with single detection (NWR AUC=0.746, 95% confidence interval: 0.707-0.814; LWR AUC=0.739, 95% confidence interval: 0.681-0.792; CEA AUC=0.572, 95% confidence interval: 0.509-0.633; CA125 AUC=0.635, 95% confidence interval: 0.573-0.694). Conclusions The combined detection of NWR, LWR, CEA and CA125 has a certain predictive value for the differential diagnosis of colon cancer and colon adenoma, and can assist in the diagnosis of colon cancer.