摘要
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.
Abstract
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.
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