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目的探讨联合检测D-二聚体、脂蛋白和癌胚抗原对恶性胃肠道肿瘤的诊断价值。方法选择胃肠道恶性肿瘤患者139例和健康体检者155例,采用胶乳增强免疫比浊法测定D-二聚体水平,直接法测定血清高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)和脂蛋白(a)[Lipoprotein(a),Lp(a)]水平,化学发光法测定血清癌胚抗原(carcino-embryonic antigen,CEA)水平。应用SPSS13.0统计软件分析每种检测指标的敏感性、特异性,并找到合适的检测组合。结果胃肠道恶性肿瘤患者血清D-二聚体、LDL、LP(a)水平明显高于健康体检者(P<0.001),HDL水平明显低于健康体检者(P<0.001);D-二聚体诊断分界点为0.495μg/ml,敏感性为62.6%,特异性为86.5%;HDL诊断分界点为1.025 mmol/L,敏感性为72.7%,特异性为85.2%;LDL的诊断分界点为3.375 mmol/L,敏感性为54%,特异性为82.6%;LP(a)诊断分界点为27.3 mg/dl,诊断的敏感性为58.3%,特异性为87.1%;CEA诊断分界点为2.14 ng/ml,敏感性为59.7%,特异性为76.8%;HDL+CEA的敏感性为77.7%,特异性为88.4%;D-二聚体+HDL的敏感性为70.5%,特异性为96.1%;HDL+LP(a)的敏感性为76.3%,特异性为93.5%;D-二聚体+HDL+LP(a)的敏感性为84.2%,特异性为92.3%;D-二聚体+HDL+CEA的敏感性为87.1%,特异性为85.8%;HDL+LP(a)+CEA的敏感性为85.6%,特异性为92.3%;D-二聚体+HDL+LP(a)+CEA的敏感性为89.9%,特异性为92.3%。结论 D-二聚体和脂蛋白可以像CEA一样作为肿瘤标志物,其联合检测具有很高的敏感性和特异性,对恶性胃肠道肿瘤具有重要的诊断价值。
Objective To investigate the diagnostic value of combined detection of D-dimer, lipoprotein and carcinoembryonic antigen in malignant gastrointestinal tumors. Methods One hundred and ninety-nine patients with gastrointestinal cancer and 155 healthy volunteers were enrolled in this study. D-dimer was measured by latex enhanced turbidimetry. The serum levels of HDL, HDL, (LDL) and lipoprotein (a) [Lipoprotein (a), Lp (a)] were detected by enzyme linked immunosorbent assay (ELISA). The levels of carcinoembryonic antigen (CEA) SPSS 13.0 statistical software was used to analyze the sensitivity and specificity of each test index, and find the appropriate test combination. Results The levels of serum D-dimer, LDL and LP (a) in patients with gastrointestinal cancer were significantly higher than those in healthy subjects (P <0.001), HDL levels were significantly lower than those in healthy subjects (P <0.001) The diagnostic demarcation point of polymer was 0.495μg / ml, with a sensitivity of 62.6% and a specificity of 86.5%. The diagnostic cutoff point of HDL was 1.025 mmol / L, with a sensitivity of 72.7% and a specificity of 85.2% Was 3.375 mmol / L, with a sensitivity of 54% and a specificity of 82.6%. The diagnostic cutoff point of LP (a) was 27.3 mg / dl, with a diagnostic sensitivity of 58.3% and a specificity of 87.1%. The cut- 2.14 ng / ml, the sensitivity was 59.7% and the specificity was 76.8%. The sensitivity and specificity of HDL + CEA were 77.7% and 88.4%, respectively. The sensitivity of HDL + CEA was 70.5% and the specificity was 96.1%. The sensitivity and specificity of HDL + LP (a) were 76.3% and 93.5%, respectively. The sensitivity and specificity of D-dimer + HDL + LP were 84.2% and 92.3% The sensitivity of HDL + LPA + CEA was 87.1% with a specificity of 85.8%; the sensitivity of HDL + LP (a) + CEA was 85.6% with a specificity of 92.3%; the D-dimer + HDL + LP a) + CEA had a sensitivity of 89.9% and a specificity of 92.3%. Conclusion D-dimer and lipoprotein can be used as tumor markers like CEA. The combined detection of D-dimer and lipoprotein has high sensitivity and specificity, which has important diagnostic value for malignant gastrointestinal tumors.