常见血清学指标对结直肠息肉癌变的预测价值分析

Predictive Value Analysis of Common Serological Indexes in Colorectal Polyp Canceration

摘要: 目的：总结分析结直肠息肉相关的常见血清学指标，研究癌变高危因素。方法：回顾性分析青岛大学附属医院2171例结直肠息肉患者，分为息肉组、癌变组，分别1820例、351例。收集各组病例的血清学指标和BMI进行统计学分析。结果：癌变组和息肉组在LDL-C、TC、TG、ALP、CEA、BMI、NLR方面差异有统计学意义(P < 0.05)；其中LDL-C、TC、TG、BMI方面，癌变组中位数明显低于息肉组，ALP、CEA、NLR方面，癌变组中位数明显高于息肉组。Logistic回归分析发现，LDL-C、CEA、NLR为结直肠息肉癌变的独立危险因素；Spearman相关性分析显示LDL-C与结直肠息肉癌变呈负相关，CEA、NLR与结直肠息肉癌变呈正相关；绘制ROC曲线，LDL-C的AUC为0.5778，取<2.435为最佳截断值，敏感度为39.32%，特异度为74.62%；CEA的AUC为0.7306，取>2.685为最佳截断值，敏感度为64.10%，特异度为72.42%；NLR的AUC为0.6947，取>2.215为最佳截断值，敏感度为51.57%，特异度为79.51%。联合诊断时虽然AUC为0.6734，无明显的改善，但敏感度明显升高。结论：较低的低密度脂蛋白胆固醇、较高的粒淋比和癌胚抗原是结直肠息肉癌变的高危因素，可作为结直肠息肉癌变的预测指标，三者联合诊断可明显提高其敏感性。

Abstract: Objective: To summarize and analyze the common serological indexes related to colorectal polyps and study the high-risk factors of canceration. Methods: 2171 patients with colorectal polyps in the Affiliated Hospital of Qingdao University were analyzed retrospectively. They were divided into polyp group and canceration group, 1820 cases and 351 cases respectively. The serological indexes and BMI of each group were collected for statistical analysis. Results: There were significant differences in LDL-C, TC, TG, ALP, CEA, BMI and NLR between canceration group and polyp group (P < 0.05); in terms of LDL-C, TC, TG and BMI, the median of canceration group was significantly lower than that of polyp group. In terms of ALP, CEA and NLR, the median of canceration group was significantly higher than that of polyp group. Logistic regression analysis showed that LDL-C, CEA and NLR were independent risk factors for colorectal polyp canceration; Spearman correlation analysis showed that LDL-C was negatively correlated with colorectal polyp canceration, and CEA and NLR were positively correlated with colorectal polyp canceration; plot the ROC curve: The AUC of LDL-C was 0.5778, and <2.435 was the best cut-off value. The sensitivity was 39.32% and the specificity was 74.62%; the AUC of CEA was 0.7306, and >2.685 was the best cut-off value. The sensitivity was 64.10% and the specificity was 72.42%; the AUC of NLR is 0.6947, and >2.215 is the best cutoff value. The sensitivity is 51.57% and the specificity is 79.51%. Although the AUC of the combined diagnosis was 0.6734, no significant improvement, but a marked increase in sensitivity. Conclusion: Low LDL cholesterol, high granulocyte to lymph ratio and carcinoembryonic antigen are high risk factors for colorectal polyp canceration, which can be used as predictors of colorectal polyp canceration. The combined diagnosis of the three can significantly improve its sensitivity.