结直肠癌血清纤维蛋白原和炎性介质、肿瘤标志物的术前诊断价值

目的探讨纤维蛋白原FIB、炎性介质（CRP、SAA）和肿瘤标志物（CEA、CA19-9、CA72-4）在术前评估结直肠癌分期的价值。方法178例经病理诊断为结直肠癌的患者，均于术前3天测定FIB、CRP、SAA、CEA、CA19-9和CA72-4的水平，并与术后病理分期相比较。结果FIB与CRP、SAA、CEA和CA19-9的相关性有统计学意义，相关系数分别为0.600（ P =0.000）、0.547（ P=0.000）、0.168（ P =0.025）、0.231（ P =0.002）。FIB（ P =0.000）、CRP( P =0.004)、SAA( P =0.046)、CEA( P =0.001)、CA19-9（ P =0.000）和CA724( P =0.040)的值在不同的TNM分期之间差异有统计学意义。 建立诊断转移性结直肠癌的ROC曲线，FIB的ROC曲线下面积A_Z=0.728（ P =0.000），CRP的A_Z=0.646（ P =0.001），SAA的A_Z=0.658（ P =0.042），CA19-9的A_Z=0.665（ P =0.000），CA72-4的A_Z=0.586（ P =0.049）有统计学意义；当取FIB=3.715g/L为分界点时，FIB诊断转移性结直肠癌的敏感度为65.8%，特异性为66.6%，准确性为66.3%。结论FIB、炎性介质和肿瘤标志物有相关性，运用FIB术前评估有淋巴结转移的结直肠癌患者有潜在应用价值。

Values for Preoperative Staging of Fibrinogen, Inflammatory Mediators and Tumor Markers in Colorectal Cancer

Objective To evaluate the value for preoperative assessment of serum fibrinogen (FIB), inflammatory mediators（C-reactive protein, CRP; serum amyloid A protein, SAA）and tumor markers (CEA, CA19-9, CA72-4) in colorectal cancer. Methods One hundred and Seventy-eight patientswith colorectal cancer were recruited. The data were pooled to analyze the relationship　between the levels of serum FIB, CRP, SAA, CEA, CA19-9, CA72-4 measured preoperatively and compared with postoperativepathological stages postoperative. Results There were statistical differences of correlations between levels of FIB and CRP, SAA, CEA, CA19-9, of which the correlation coefficients were 0.600, 0.547, 0.168and0.231, respectively. The levels of FIB ( P =0.000), CRP( P =0.004), SAA( P =0.046), CEA( P =0.001), CA19-9( P =0.000) and CA72-4( P =0.040) were　significant difference in TNM stages. Contriving the ROC curve for metastatic colorectal cancer, the area under curve of FIB (A_Z=0.728), CRP(A_Z=0.646), SAA (A_Z=0.658), CA19-9 (A_Z=0.665)and CA72-4(A_Z=0.586) also hadstatistical significance, of which theP values were 0.000, 0.001, 0.042, 0.000and 0.049, respectively. While the critical point of FIB was defined as 3.715g/L, the accuracy, sensitivityand specificity ofthe prediction to metastatic colorectal cancer were 65.84%, 66.6%,66.3%,respectively. Conclusion Therelationships between FIB, inflammatory mediators and tumor markers were observed. Using FIB to evaluate colorectal patients with lymphatic metastasis preoperatively has potentially clinical value.