發(fā)布時間：2018-02-27 16:37

  本文關(guān)鍵詞： 同型半胱氨酸 腫瘤標(biāo)志物 結(jié)直腸癌　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景直腸癌是我國高發(fā)的消化道惡性腫瘤。2017年NCCN指南顯示,美國結(jié)直腸癌的發(fā)病率居其所有惡性腫瘤的第4位,但死亡率卻呈現(xiàn)明顯的下降趨勢,分析其原因可能得益于美國注重早期篩查、早期診斷的完善實施,以及更加優(yōu)良的治療手段的進(jìn)步。目前,我國醫(yī)療的早期篩查和早期診斷尚存在一定的欠缺,提高疾病篩查的有效性迫在眉睫。臨床上常用的結(jié)直腸癌及癌前病變主要篩選方法包括:基于高風(fēng)險因素的問卷調(diào)查,直腸指檢,糞便潛血試驗,電子結(jié)腸鏡檢查和病理檢查。這些檢查方法用于結(jié)直腸癌的早期篩查、早期診斷都具有一定的局限性。近年來隨著研究的不斷更新,同型半胱氨酸(Homocysteine,Hcy)作為一種全新的腫瘤危險因素得到廣泛的關(guān)注。文獻(xiàn)報道Hcy在消化、呼吸、生殖、內(nèi)分泌系統(tǒng)的惡性腫瘤中具有一定的診斷價值。將血清Hcy作為血清腫瘤標(biāo)志物用于惡性腫瘤的早期診斷、治療、預(yù)后判斷、病情復(fù)發(fā)的監(jiān)測可能具有廣闊的應(yīng)用前景。但有關(guān)Hcy與直腸癌的相關(guān)性研究未見報道,因此,本課題以Hcy做為研究指標(biāo),初步探討Hcy與直腸癌發(fā)生發(fā)展的相關(guān)性,為Hcy作為直腸癌早期篩查與診斷的潛在指標(biāo)提供初步的理論依據(jù)。研究目的通過比較正常人群,直腸息肉患者與直腸癌患者的血清Hcy水平,以及不同病理分期直腸癌患者的血清Hcy水平,探討檢測血清Hcy水平對直腸病變早期篩查和早期診斷的價值,研究Hcy與直腸癌病理分期的相關(guān)性。研究方法隨機(jī)選取2015年5月-2017年2月期間于山東大學(xué)齊魯醫(yī)院入住消化內(nèi)科、普外科、腫瘤科等三個科室的住院患者共計233例,其中直腸息肉患者共計101例,直腸癌患者共計132例,另隨機(jī)選取正常人群80例,病例共計313例。根據(jù)電子纖維腸鏡及病理分析結(jié)果,將研究對象分為正常人群組、直腸息肉患者組、直腸癌患者組。另外,參照息肉切除術(shù)術(shù)后病理結(jié)果,根據(jù)高危腺瘤定義,將直腸息肉患者分為兩個亞組:低危組(n=84)和高危組(n=17)。參照惡性腫瘤患者的手術(shù)記錄、術(shù)后病理分析結(jié)果及術(shù)前相關(guān)影像學(xué)檢查的結(jié)果,根據(jù)美國癌癥聯(lián)合會(AJCC)第7版分期標(biāo)準(zhǔn)將直腸癌患者分為4個亞組:Ⅰ期組(n=28)、Ⅱ期組(n=38)、Ⅲ期組(n=48)和ⅣV期組(n=18)。比較各組Hcy及其他腫瘤標(biāo)志物指標(biāo)的差異并分析其與直腸癌的發(fā)生及直腸癌不同病理分期的相關(guān)性。對血清Hcy水平的檢測采用單循環(huán)酶法。所有檢測數(shù)據(jù)采用SPSS 18.0軟件進(jìn)行統(tǒng)計分析。結(jié)果1.血清中Hcy水平在正常人群、直腸息肉低危組、直腸息肉高危組以及各期直腸癌之間逐漸升高,且組間有顯著差異(p=0.006、0.017、0.001、0.001、0.001、0.001);在7個亞組中,直腸息肉低危組與直腸息肉高危組、Ⅰ期直腸癌組無統(tǒng)計學(xué)差異(p=0.459、0.102),直腸息肉低危組與Ⅱ期-Ⅳ期直腸癌組存在顯著差異(p=0.001、0.001、0.001);直腸息肉高危組與Ⅰ期直腸癌無明顯統(tǒng)計學(xué)差異(p=0.592),與Ⅱ期-Ⅳ期直腸癌存在顯著差異(p=0.018、0.001、0.001);Ⅰ期直腸癌與Ⅱ期-Ⅳ期直腸癌存在顯著差異(p=0.035、0.001、0.001);Ⅱ期直腸癌與Ⅳ期直腸癌存在顯著差異(p=0.017)。2.Hcy與直腸病變進(jìn)展具有顯著的相關(guān)性,其相關(guān)系數(shù)為0.490,p0.001。Hcy與直腸癌的分期存在顯著的相關(guān)性,其相關(guān)系數(shù)為0.186,p=0.006。Hcy與直腸息肉低危組以及高危組之間無明顯的相關(guān)性,其相關(guān)系數(shù)為0.094,p=0.386。Hcy在是否患直腸癌的相關(guān)性上是顯著的,相關(guān)系數(shù)是0.487,p0.001。3.Logistic回歸分析顯示,經(jīng)校正年齡、性別、腫瘤標(biāo)志物等其他危險因素后,其 OR(95%CI)= 1.186(1.051-1.338),p=0.006,血清 Hcy 水平依然與直腸癌的發(fā)生顯著相關(guān),且優(yōu)于其他腫瘤標(biāo)志物。結(jié)論1.血清中Hcy水平隨著直腸病變進(jìn)展逐漸升高。2.血清中Hcy水平是直腸癌的相關(guān)因素,且獨立于年齡、性別和其他腫瘤標(biāo)志物;3.血清中Hcy水平具有應(yīng)用于直腸癌早期篩查診斷和檢測的潛在可能性。
[Abstract]:The research background of rectal cancer with high incidence in China is a malignant tumor of digestive tract.2017 NCCN guidelines, the incidence rate of colorectal cancer in the United States fourth of all malignant tumors, but the mortality rate is decreased obviously, analysis of the reasons may be due to the United States focus on early screening, early diagnosis and improve the implementation and progress, more excellent treatment. At present, the early screening and early diagnosis of medical treatment in our country there are still some deficiencies, improve the effectiveness of screening for the disease is imminent. Including clinical colorectal cancer and cancer lesions commonly used before the main screening methods: questionnaire survey of high risk factors based on digital rectal examination, fecal occult blood test, colonoscopy and pathological examination. The examination method for early colorectal cancer screening, early diagnosis has some limitations. In recent years, with the development of the research of new type. Cysteine (Homocysteine, Hcy) as a new tumor risk factors have received extensive attention. Reported that Hcy in the digestive, respiratory, reproductive, endocrine system has some value in the diagnosis of malignant tumors. The serum Hcy as a serum tumor marker for early diagnosis of malignant tumor, treatment, prognosis, monitoring relapse may have broad application prospects. But the correlation between Hcy and colorectal cancer has not been reported. Therefore, this paper takes Hcy as the research target, preliminary study on relationship between Hcy and the occurrence and development of colorectal cancer, and provide the theoretical basis for the Hcy as a potential marker for early screening and diagnosis of colorectal cancer. The purpose of the study is to compare the normal population the level of serum Hcy in patients with colorectal polyps, and colorectal cancer patients, and different pathological stages of colorectal cancer patients serum Hcy level, serum Hcy level detection The rectal lesions early screening and early diagnosis, correlation between Hcy and pathologic staging of rectal cancer. Methods randomly selected from May 2015 -2017 year in February in Qilu Hospital of Shandong University in the Department of Gastroenterology, Department of general surgery, Department of oncology and other three departments of the inpatients were 233 cases, including rectal polyps in patients with a total of 101 cases, a total of 132 patients with rectal cancer another example, randomly selected 80 normal subjects, 313 cases of electronic colonoscopy and pathology. According to the analysis results, the subjects were divided into normal group, group of patients with rectal polyps, patients of rectal cancer. In addition, according to polyp resection pathology results, according to the definition of high-risk adenoma, patients with rectal polyps were divided into two sub groups: low risk group (n=84) and high risk group (n=17). According to the surgical records of patients with malignant tumors, and the analysis result of preoperative imaging examination results of pathology after operation , according to the American Cancer Association (AJCC) seventh edition staging rectal cancer patients were divided into 4 groups: group I (n=28), group II (n=38), group III and IV (n=48) V group (n=18). Compare the differences in groups Hcy and other tumor markers and the analysis and the occurrence of colorectal cancer and colorectal cancer in different pathological stages. The correlation detection of the serum Hcy level by cyclophorase method. All test data were statistically analyzed by SPSS 18 software. Results 1. serum levels of Hcy in the normal population, rectal polyps in low risk group, high risk group and the rectal polyps between rectal cancer gradually increased, and there were significantly different between groups (p=0.006,0.017,0.001,0.001,0.001,0.001); in the 7 subgroups, rectal polyps in low risk group and high risk group of rectal polyps, there was no significant difference in stage I rectal cancer group (p=0.459,0.102), rectal polyps in low risk group and II - IV colorectal cancer group deposit There were significant differences (p=0.001,0.001,0.001); rectal polyps in high-risk group with primary rectal cancer had no significant difference (p=0.592), there was significant difference with II - IV colorectal cancer (p=0.018,0.001,0.001); there were significant differences in phase I and II - IV colorectal rectal cancer (P =0.035,0.001,0.001); there were significant differences in stage II rectal cancer with stage IV colorectal cancer (p=0.017) in.2.Hcy and rectal lesions had significant correlation, the correlation coefficient is 0.490, and the p0.001.Hcy staging of rectal cancer has significant correlation, the correlation coefficient is 0.186, there is no obvious correlation between p= and 0.006.Hcy rectal polyps in low risk group and high risk group, the correlation coefficient is 0.094, p=0.386.Hcy is significant in whether the correlation between rectal cancer is 0.487, correlation coefficient, p0.001.3.Logistic regression analysis showed that after adjusting for age, gender, tumor markers and other risk factors After the OR (95%CI) = 1.186 (1.051-1.338), p=0.006, serum Hcy level is still significantly associated with the occurrence of colorectal cancer, and is superior to other tumor markers. Conclusion the level of Hcy 1. in serum with rectal lesions progress gradually increased the level of Hcy.2. in serum of colorectal cancer is related factors, and independent of age and gender. Other potential tumor markers; Hcy 3. level in serum is applied to colorectal cancer screening and early diagnosis test.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.37

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