目的 探讨血清人附睾蛋白4(HE4)水平及卵巢癌风险预测模型(ROMA)指数对CA125升高卵巢良、恶性肿瘤的鉴别诊断价值.方法 选取2020年6月至2021年6月浙江省肿瘤医院妇瘤外科首诊手术治疗并经病理检查证实的卵巢恶性肿瘤97例(恶性组)和卵巢良性肿瘤61例(良性组),比较两组患者血清CA125、HE4水平以及ROMA指数的差异,采用ROC曲线分析血清HE4水平和ROMA指数诊断CA125阳性的卵巢恶性肿瘤的AUC.结果 恶性组患者血清CA125、HE4水平以及ROMA指数均高于良性组,差异均有统计学意义(均P＜0.01).在CA125阳性卵巢疾病中,恶性组的血清HE4水平和ROMA指数和阳性率均高于良性组,差异均有统计学意义(均P＜0.01).CA125阳性的14例良性组患者血清HE4均阴性.ROC曲线分析显示,在CA125阳性的患者中,血清HE4诊断卵巢恶性肿瘤AUC为0.941(95％CI:0.895～0.988);ROMA指数诊断卵巢恶性肿瘤AUC分别为绝经前0.897(95％CI:0.793～1.000)、绝经后0.937(95％CI:0.872～1.000).结论 血清HE4水平和ROMA指数对CA125升高的卵巢良、恶性肿瘤具有良好的鉴别诊断价值,值得临床推广.

目的 探究分析D-二聚体、CEA、CA242、CA50 联合检测对结肠癌的诊断和鉴别诊断价值.方法 选取浙江省肿瘤医院2019 年3 月-6 月132 例首诊结肠癌患者、54 例结肠非癌性息肉患者和45 例健康人分别为结肠癌组、结肠非癌性息肉组和对照组,分析各组D-二聚体、CEA、CA242、CA50水平并计算诊断效率,比较不同分期结肠癌的相应水平.结果 结肠癌组较对照组D-二聚体、CEA、CA242、CA50 水平明显升高(P＜0.01).结肠非癌性息肉组CEA 与对照组相比明显升高(P＜0.01).D-二聚体联合3种肿瘤标志物诊断结肠癌的AUC为0.875.Ⅳ期结肠癌D-二聚体、CEA、CA242、CA50水平同比上期升高(P＜0.01).结肠非癌性息肉3种不同病理类型各指标水平差异无统计学意义(P＞0.05).结论 联合检测D-二聚体和CEA、CA242、CA50 可以提高结肠癌的诊断效率.同时,有助于结肠癌病情的判断,尤其对伴远处转移的Ⅳ期结肠癌意义较大.

目的 探讨术前血液中性粒细胞与淋巴细胞比值(NLR)在结肠癌患者中的表达及临床意义.方法 选取2019年1～8月浙江省肿瘤医院收治的230例结肠癌患者作为结肠癌组,选取同期161例健康人群作为健康对照组.比较两组的血液NLR,同时收集结肠癌患者术后常规病理,比较不同病理特征的血液NLR.结果 结肠癌组的血液NLR高于健康对照组,差异有统计学意义(P<0.01).M1期结肠癌患者的血液NLR高于M0期,差异有统计学意义(P<0.05).肿瘤最大直径≥5 cm的结肠癌患者血液NLR高于最大直径<5 cm的患者,差异有统计学意义(P<0.01).不同发生位置、分化类型、形态特征结肠癌患者的血液NLR比较,差异无统计学意义(P>0.05).结论 术前检测结肠癌患者的血液NLR可反映患者与肿瘤相关的炎症状态,并提示肿瘤远处转移情况和肿瘤大小,对结肠癌的治疗和预后分析具有临床意义.

Objective:To analyze the value of combined detection of C reactive protein (CRP), serum amyloid A (SAA), carcinoembryonic antigen (CEA), carbohydrate antigen (CA)242, CA50 in the diagnosis of colon cancer.Methods:177 inpatients with first-diagnosed colon cancer in Cancer Hospital of University of Chinese Academy of Sciences from January 2019 to June 2019, 74 patients with non-cancerous colonic polyps, 58 healthy subjects were respectively collected as colon cancer group, colonic polyps group and healthy control group. The levels of CRP, SAA, CEA, CA242 and CA50 in each group were compared and the diagnostic efficiency was calculated. The significance in different stages of colon cancer was evaluated.Results:The levels of CRP, SAA, CEA, CA242 and CA50 in colon cancer group were significantly higher than those in colonic polyps group and healthy control group ( P<0.05); the levels of CRP, SAA and CEA in colonic polyps group were significantly higher than those in healthy control group ( P<0.05). The area under the curve (AUC) of CRP, SAA, CEA, CA242 and CA50 in the diagnosis of colon cancer was 0.818, and the sensitivity and specificity were higher than those of single detection ( P<0.05). The levels of CRP, SAA, CEA, CA242 and CA50 in stage Ⅳ colon cancer were significantly higher than those in stage 0-Ⅲ ( P<0.05). Conclusions:The combined detection of CRP, SAA, CEA, CA242, CA50 can improve diagnostic efficiency of colon cancer. Besides, the detected levels of CRP, SAA, CEA, CA242 and CA50 are helpful to the diagnosis of colon cancer, especially in stage Ⅳ colon cancer with distant metastasis.