标题：经直肠超声联合血清CEA、CYFRA21-1对直肠癌患者的诊断价值

      作者：许艳 1，徐灵 2，索永刚 1，钱紫娟 1    上海中冶医院功能科 1、检验科 2，上海 200941

      卷次： 2020年31卷13期

      【摘要】 目的 研究经直肠超声联合血清癌胚抗原(CEA)、C角蛋白19片段抗原21-1 (CYFRA21-1)对直肠癌患者的诊断价值。方法 选取上海中冶医院2017年5月至2019年5月收治的100例直肠癌患者作为病变组，另取同期于我院体检的健康人员100例作为对照组。所有受检者均进行经直肠超声检测，比较两组受检者的相关血流动力学参数水平。以酶联免疫吸附法检测并比较两组受检者的血清CEA以及CYFRA21-1水平。以病理学诊断结果为参照，分析经直肠超声、血清CEA、CYFRA21-1以及三项联合诊断直肠癌患者的敏感度、特异度、准确度。此外，比较淋巴结转移和无淋巴结转患者血清CEA、CYFRA21-1水平。结果 病变组患者的舒张末期流速(EDV)水平为(5.51±0.94) cm/s，明显高于对照组的(2.15±0.48) cm/s，而阻力指数(RI)、搏动指数(PI)分别为0.67±0.05、1.57±0.62，明显低于对照组的 0.82±0.08、2.41±0.65，差异均有显著统计学意义(P<0.01)；病变组患者的血清CEA、CYFRA21-1水平分别为(19.74±4.20) μg/L、(5.41±1.97) ng/mL，明显高于对照组的(2.31±1.55) μg/L、(1.37±0.55) ng/mL，差异均有显著统计学意义(P<0.01)；经直肠超声联合血清CEA、CYFRA21-1诊断直肠癌的敏感度、特异度、准确度分别为 95.00%、98.00%、96.50%，明显高于经直肠超声的 82.00%、88.00%、85.00%，CEA的 65.00%、85.00%、75.00%和血清 CYFRA21-1的 68.00%、83.00%、75.50%；直肠癌淋巴结转移患者的血清 CEA、CYFRA21-1水平分别为(25.32±5.11) μg/L、(7.12±2.04) ng/mL，明显高于无淋巴结转移患者的(14.02±4.01) μg/L、(3.98±1.75) ng/mL，差异均有显著统计学意义(P<0.01)。结论 经直肠超声联合血清CEA、CYFRA21-1诊断直肠癌患者的临床价值较高，且有助于淋巴结转移的检出。
      【关键词】 直肠癌；经直肠超声；癌胚抗原；C角蛋白19片段抗原21-1；诊断价值
      【中图分类号】 R735.3+7 【文献标识码】 A 【文章编号】 1003—6350（2020）13—1672—04

Diagnostic value of transrectal ultrasound combined with CEA and CYFRA21-1 in patients with rectal cancer.XU Yan 1, XU Ling 2, SUO Yong-gang 1, QIAN Zi-juan 1.
Department of Function 1, Department of Clinical Laboratory 2,Shanghai MCC Hospital, Shanghai 200941, CHINA
【Abstract】 Objective To study the diagnostic value of transrectal ultrasound combined with serum CEA andCytokerantin-19-fragment antigen 21-1 (CYFRA21-1) in patients with rectal cancer. Methods One hundred rectalcancer patients admitted to Shanghai MCC Hospital from May 2017 to May 2019 were selected as the pathologicalgroup, and another 100 healthy people in the hospital during the same period were selected as the control group. Tran-srectal ultrasound was performed in both groups to compare the levels of relevant hemodynamic parameters. Serum CEAand CYFRA21-1 levels of the two groups were detected and compared by enzyme-linked immunosorbent assay. Thesensitivity, specificity, and accuracy of transrectal ultrasound, serum CEA, CYFRA21-1 and three combined methods inthe diagnosis of rectal cancer were compared according to the pathological diagnosis results. In addition, serum CEA andCYFRA21-1 levels in patients with and without lymph node metastasis were compared. Results The level of end-dia-stolic velocity (EDV) in the pathological group was (5.51±0.94) cm/s, significantly higher than (2.15±0.48) cm/s in thecontrol group, while the resistance index (RI) and pulse index (PI) were 0.67±0.05 and 1.57±0.62, significantly lowerthan 0.82±0.08 and 2.41±0.65 in the control group (P<0.01). Serum CEA and CYFRA21-1 levels in the lesion groupwere (19.74±4.20) μg/L and (5.41±1.97) ng/mL, respectively, which were significantly higher than (2.31±1.55) μg/L and(1.37±0.55) ng/mL in the control group (P<0.01). The sensitivity, specificity, and accuracy of transrectal ultrasound com-bined with serum CEA and CYFRA21-1 in the diagnosis of rectal cancer were 95.00%, 98.00%, 96.50%, respectively,significantly higher than 82.00%, 88.00%, 85.00% of transrectal ultrasound, 65.00%, 85.00%, 75.00% of serum CEA,and 68.00%, 83.00%, and 75.50% of serum CYFRA21-1. Serum CEA and CYFRA21-1 levels of patients with lymphnode metastasis of rectal cancer were (25.32 ± 5.11) μg/L, (7.12 ± 2.04) ng/mL, respectively, significantly higher than(14.02±4.01) μg/L, (3.98±1.75) ng/mL in patients without lymph node metastasis (P<0.01). Conclusion Transrectal ul-trasound combined with serum CEA and CYFRA21-1 is of high clinical value in the diagnosis of rectal cancer patientsand it is conducive to the detection of lymph node metastasis.
      【Key words】 Rectal cancer; Transrectal ultrasound; Carcinoembryonic antigen; Cytokerantin-19-fragment anti-gen21-1; Diagnostic value