目的 分析结直肠癌和结直肠癌肝转移患者的中医证及临床相关因素,探寻结直肠癌发生肝转移中医病机相关因素及客观指标。方法 采用前瞻性流行病学的调查方法,分析研究患者临床流行病学资料和肿瘤标志物水平。结果 结直肠癌发生肝转移与是否脾虚相关具有统计学意义(P＜0.05),与病理分型有关,其中溃疡性腺癌更易发生肝转移具有统计学意义(P＜0.05),与肿瘤侵犯程度有关,侵犯浆膜下或无腹膜覆盖的结直肠旁组织更易发生肝转移具有统计学意义(P＜0.01),与淋巴结转移数有关具有统计学意义(P＜0.01),与血清CEA,CA242,CA19-9,CA50,CA724,CA125,CA153,血浆D-二聚体有关具有统计学意义(P＜0.05),ROC曲线分析诊断效能：联合检测＞血清CEA＞血清CA242＞血清CA199＞血浆D-二聚体＞血清CA125＞血清CA724＞血清CA50＞血清CA125。结直肠癌与结直肠癌肝转移脾虚患者血清CEA,CA199,CA125,血浆D-二聚体诊断阳性率高于非脾虚患者(P＜0.05)。结论 中医辨证是否脾虚，以及年龄，肿瘤病理分型，侵犯程度，肠周淋巴结转移数，血清CEA，CA153，CA242，CA199，CA50，CA724，CA125，血浆D-二聚体与结直肠发生肝转移高度相关，几种肿瘤指标联合检测能增加诊断率，首次研究发现血清CEA，CA199，CA125，血浆D-二聚体可作为结直肠癌与结直肠癌肝转移脾虚证量化指标，对结直肠癌发生肝转移的监测、诊断及中西医治疗具有临床指导意义。转移的监测、诊断及中西医治疗具有临床指导意义。
Objective To analyze the TCM syndromes and clinical related factors of patients with colorectal cancer and colorectal cancer with liver metastasis, and to explore the related factors and objective indicators of TCM pathogenesis of liver metastases from colorectal cancer. Methods Prospective epidemiological investigation methods were used to analyze clinical epidemiological data and tumor marker levels. Results The liver metastasis of colorectal cancer was statistically significant (P<0.05), which was related to pathological type. The ulcerative adenocarcinoma was more likely to have liver metastasis (P<0.05), which was related to the degree of tumor invasion. There was a statistically significant difference in liver metastasis between the subserosal or non-peritoneal tissues (P<0.01), which was statistically significant (P<0.01), and serum CEA, CA242, CA19. -9, CA50, CA724, CA125, CA153, plasma D-dimer was statistically significant (P<0.05), ROC curve analysis diagnostic efficacy: combined detection> serum CEA> serum CA242> serum CA199> plasma D-two Polymer > serum CA125 > serum CA724 > serum CA50 > serum CA125. The positive rate of serum CEA, CA199, CA125 and plasma D-dimer in patients with colorectal cancer and colorectal cancer liver metastasis was higher than that in patients with non-spleen deficiency (P<0.05). Conclusion TCM syndrome differentiation is spleen deficiency, as well as age, tumor pathological type, degree of invasion, number of intestinal lymph node metastasis, serum CEA, CA153, CA242, CA199, CA50, CA724, CA125, plasma D-dimer and colorectal liver metastasis Highly correlated, combined detection of several tumor markers can increase the diagnostic rate. The first study found that serum CEA, CA199, CA125, plasma D-dimer can be used as a quantitative indicator of colorectal cancer and colorectal cancer liver metastasis spleen deficiency syndrome, for colorectal cancer The monitoring, diagnosis and treatment of liver metastasis with liver metastasis have clinical guiding significance.
]国家自然科学基金(No. 81673736)和江苏省研究生科研与实践创新计划项目(No. SJCX18_0808)