目的 探讨血清胰岛素样生长因子结合蛋白7(IGFBP7)、糖类抗原199(CA199)、生长分化因子15(GDF-15)表达水平与结直肠癌(CRC)患者临床病理特征及预后相关性.方法 选取CRC患者为CRC组(n=87),收集整理其肿瘤位置、病理类型、TNM分期等临床病理特征资料.另选取同期治疗的结直肠息肉患者为良性疾病组(n=87),同期体检的健康志愿者作为对照组(n=87).ELISA法检测血清IGFBP7、GDF-15水平,电化学发光法测定CA199水平.采用Kaplan-Meier法分析CRC患者IGFBP7、CA199、GDF-15表达与患者预后的关系;CRC患者预后的影响因素采用多因素Cox回归分析.ROC曲线分析血清IGFBP7、CA199、GDF-15诊断CRC的临床价值.结果 CRC组、良性疾病组血清IGFBP7、CA199、GDF-15水平均显著高于对照组(P＜0.05),CRC组血清IGFBP7、CA199、GDF-15水平均显著高于良性疾病组(P＜0.05).淋巴结发生转移、TNM分期为Ⅲ+Ⅳ、细胞分化程度为低分化的CRC患者IGFBP7、CA199、GDF-15高表达比例均显著高于淋巴结未发生转移、TNM分期为Ⅰ+Ⅱ、细胞分化程度为中/高分化的CRC患者(P＜0.05);IG-FBP7、CA199、GDF-15高表达组患者3年生存率均显著低于其对应的低表达组(P＜0.05);淋巴结转移、TNM分期、IG-FBP7、CA199、GDF-15均是CRC患者死亡的危险因素(P＜0.05).血清IGFBP7、CA199、GDF-15三项联合诊断CRC的AUC优于各自单独诊断(Z三者联合 vs IGFBP7=4.086、Z三者联合 vs CA199=4.815、Z三者联合 vs GDF-15=5.477,P均＜0.05).结论 CRC患者血清IGFBP7、CA199、GDF-15表达水平升高,与患者临床病理特征及预后关系密切,三项指标联合诊断CRC具有较高的效能.
The Correlation Between the Expression Levels of Serum IGFBP7,CA199,and GDF-15 and the Clinical Pathological Characteristics and Prognosis of Colorectal Cancer Patients
Objective To investigate the relationship between the expression levels of serum insulin-like growth factor-binding protein 7(IGFBP7),carbohydrate antigen 199(CA199),and growth differentiation factor 15(GDF-15)and the clinical pathological characteristics and prognosis of colorectal cancer(CRC)patients.Methods CRC patients were selected as the CRC group(n=87),the clinical pathological characteristics such as tumor location,pathological type,and TNM staging were collected and organized.Additionally,patients with colorectal polyps treated during the same period were selected as the benign disease group(n=87),the healthy volunteers who underwent physical examination during the same period were selected as the control group(n=87).ELISA method was applied to detect serum IGFBP7 and GDF-15 levels,electrochemiluminescence method was applied to determine the level of CA199;the relationship between the expression of IGFBP7,CA199,GDF-15 and the prognosis of CRC patients was analyzed using Kaplan-Meier method;the prognostic factors of CRC patients were analyzed using multivariate Cox regression analysis;receiver operating characteristic was applied to analyze the clinical value of serum IGFBP7,CA199,and GDF-15 in the diagnosis of CRC.Results The serum levels of IGFBP7,CA199,and GDF-15 in the CRC group and benign dis-ease group were obviously higher than those in the control group(P＜0.05),while the serum levels of IGFBP7,CA199,and GDF-15 in the CRC group were obviously higher than those in the benign disease group(P＜0.05);the high expression rates of IG-FBP7,CA199,and GDF-15 in CRC patients with lymph node metastasis,TNM stage Ⅲ+Ⅳ,and low cell differentiation were ob-viously higher than those in CRC patients with no lymph node metastasis,TNM stage Ⅰ+Ⅱ,and medium/high cell differentia-tion(P＜0.05);the three-year survival rate of patients in high expression groups of IGFBP7,CA199,and GDF-15 was obviously lower than their corresponding low expression groups(P＜0.05);lymph node metastasis,TNM staging,IGFBP7,CA199,and GD-F-15 were all risk factors for mortality in CRC patients(P＜0.05);the AUC of the combined diagnosis of serum IGFBP7,CA199,and GDF-15 for CRC was superior to their respective individual diagnoses(Zcombination-IGFBP7=4.086,Zcombination-CA199=4.815,Zcombination-GDF-15=5.477,all P＜0.05).Conclusion The expression of IGFBP7,CA199,and GDF-15 in serum of CRC patients is increased,which is closely related to the clinical pathological characteristics and prognosis of the patients.The combination of these three indicators has high efficacy in diagnosing CRC.
Insulin-like growth factor-binding protein 7Carbohydrate antigen 199Growth differentiation factor 15Colorectal cancer
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