摘要
目的:探讨进展期胃癌患者外周血同型半胱氨酸(homocysteine,Hcy)水平与一线化疗疗效的相关性。方法:回顾性分析2011年9月至2016年10月收住我科49例初治进展期胃癌患者的临床资料,化疗前与化疗后均空腹静脉采血,采用酶法检测Hcy水平,电化学发光法检测癌胚抗原(carcinoembryonic antigen,CEA)、糖链抗原724(carbohydrate antigen 724,CA724)、糖链抗原242(carbohydrate antigen 242,CA242)水平。化疗方案为“紫杉醇+奥沙利铂”或“替吉奥+奥沙利铂”。经过2周期化疗后按照NCI-RECIST 1.0版分为完全缓解(complete remission,CR)、部分缓解(partial remission,PR)、稳定或无变化(stable or unchanged disease,SD)、进展(progress disease,PD)。化疗有效为CR+PR+SD,化疗无效为PD。依据疗效来绘制受试者工作特征(receiver operating characteristic,ROC)曲线,应用Youden指数计算血清Hcy最佳界限值,分为高低两组分别计算化疗的近期疗效,建立Logistic回归模型评估血清Hcy对胃癌化疗疗效的检测性能。结果:所有患者化疗前Hcy、CEA、CA724、CA242水平[(14.88±4.45)μmol/L、(32.0±18.37)μg/L、(29.3±12.71)U/mL、(40.0±21.25)U/mL]与化疗后Hcy、CEA、CA724、CA242水平[(12.78±4.0)μmol/L、(22.0±14.10)μg/L、(19.7±15.35)U/mL、(25.7±17.34)U/mL]比较,差异有统计学意义(P<0.05)。ROC曲线结果显示,化疗后Hcy、CEA、CA724、CA242 ROC曲线下面积分别为0.855、0.687、0.716、0.884。高Hcy组(Hcy>10.92μmol/L)和低Hcy组(Hcy≤10.92μmol/L)在年龄、性别、远处转移和化疗方案方面差异无统计学意义(P>0.05),但在烟酒嗜好和幽门螺杆菌(helicobacter pylori,Hp)感染方面差异有统计学意义(P<0.05)。低Hcy组的有效率(66.67%)高于高Hcy组的有效率(9.68%)(P=0.000)。以Hcy、CEA、CA724、CA242为自变量进行Logistic二元回归模型分析,该模型的Nagelkerke R 2为0.758,准确率为86.7%,Hcy的回归系数B为-0.664,P=0.01,提示血清Hcy对胃癌化疗疗效有一定的预测作用。结论:胃癌患者外周血Hcy、CEA、CA724、CA242水平在化疗过程中有相应的改变,其中血清Hcy可能是预测疗效的外周血参数指标,在临床实践中有一定的指导作用。
Objective:To investigate the correlation between peripheral blood homocysteine(Hcy)level and the efficacy of first-line chemotherapy in patients with advanced gastric cancer.Methods:The clinical data of 49 cases of advanced gastric cancer patients in our department from September 2011 to October 2016 were analyzed retrospectively,fasting venous blood was collected before and after chemotherapy.Hcy was detected by enzyme method and carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724),carbohydrate antigen 242(CA242)level was detected by electrochemiluminescence method.The chemotherapy regimen was"paclitaxel combined oxaliplatin"or"tegafur,gimeracil and oteracil potassium capsules combined oxaliplatin".After 2 cycles of chemotherapy,the patients were divided into complete remission(CR),partial remission(PR),stable or unchanged disease(SD),progress disease(PD),according to NCI-RECIST version 1.0.Chemotherapy was effective for CR,PR and SD and ineffective for PD.The receiver operating characteristic(ROC)curve of the subjects was drawn according to the curative effect.The best limit value of Hcy level was calculated by Youden index.The short-term curative effect of chemotherapy was calculated in high and low groups,and the Logistic regression model was established to evaluate the detection performance of Hcy in gastric cancer chemotherapy.Results:The levels of Hcy,CEA,CA724,CA242 before chemotherapy[(14.88±4.45)μmol/L,(32.0±18.37)μg/L,(29.3±12.71)U/mL,(40.0±21.25)U/mL]in all patients were compared with the levels of Hcy,CEA,CA724,CA242 after chemotherapy[(12.78±4.0)μmol/L,(22.0±14.10)μg/L,(19.7±15.35)U/mL,(25.7±17.34)U/mL],and the difference was statistically significant(P<0.05).Aera under ROC curve of the Hcy,CEA,CA724,CA242 was 0.855,0.687,0.716,0.884.There was no statistically significant difference between the high Hcy group(Hcy>10.92μmol/L)and the low Hcy group(Hcy≤10.92μmol/L)in terms of age,gender,distant metastasis,chemotherapy regimen(P>0.05),but there were significant differences in smoking and drinking,helicobacter pylori(Hp)infection(P<0.05).The effective rate of the low Hcy group(66.67%)was higher than that of the high Hcy group(9.68%)(P=0.000).Logistic binary regression model analysis showed the Nagelkerke R2 of the model was 0.758.The accuracy rate was 86.7%.The regression coefficient B of Hcy was-0.664,and P=0.01,suggesting the efficacy of serum Hcy on gastric cancer chemotherapy has a certain predictive effect.Conclusion:The peripheral blood Hcy,CEA,CA724 and CA242 of patients with gastric cancer were changed accordingly during chemotherapy,in which the blood Hcy may be the index of peripheral blood parameters to predict the curative effect,and it has a certain guiding role in clinical practice.
作者
张智
吉维民
严东城
庾庆丽
朱琳
沈健
ZHANG Zhi;JI Weimin;YAN Dongcheng;YU Qingli;ZHU Lin;SHEN Jian(Department of Oncology,Baoying People's Hospital,Jiangsu Yangzhou 225800,China;Department of Laboratory Medicine,Baoying People's Hospital,Jiangsu Yangzhou 225800,China)
出处
《现代肿瘤医学》
CAS
北大核心
2021年第22期3977-3981,共5页
Journal of Modern Oncology
关键词
同型半胱氨酸
胃癌
化学治疗
相关研究
homocysteine
gastric cancer
chemotherapy
correclation study
作者简介
张智(1969—),男,江苏扬州人,主任医师,主要从事肿瘤内科治疗工作,E-mail:byzzhi@sina.com。
