| ObjectiveColorectal cancer is one of the most common malignant tumors in the world and its high morbidity and mortality seriously endanger human health.Colorectal adenoma is an adenomatous polyp of the colon that is a recognized precancerous lesion of colorectal cancer.Early diagnosis and resection is of great significance for reducing the morbidity and mortality of colorectal cancer.Currently,there is no difinite serum marker for the diagnosis of colorectal adenoma.Carcinoembryonic antigen(CEA)is the most commonly used tumor marker,and Homocysteine(Hcy)has been considered as a new serum marker for colorectal cancer in recent years.In this study,the levels of serum Hcy and CEA in Patients with colorectal adenomas,patients with colorectal non-adenomatous polyps(including inflammatory or proliferative polyps),and healthy people were compared.Receiver operator characteristic(ROC)curves were depicted to explore the diagnostic value of Hcy,CEA and Hcy combined CEA in colorectal adenoma.Meanwhile,the levels of serum Hcy in different clinical types of colorectal adenoma were observed.MethodsA total of 180 patients with colorectal polyps diagnosed and treated in department of gastroenterology and colorectal and anal surgery of the First Affiliated Hospital of Zhengzhou University from September 2016 to December 2018 were collected.There were 120 patients with colorectal adenomas,including 70 males and 50 females,aged 40 to 73 years old.There were 60 patients with colorectal inflammatory or proliferative polyps,including 34 males and 26 females,aged 41 to 72 years old.In addition,a total of 60 healthy subjects,including 36 males and 24 females,aged 42 to 69 years old,were collected during the same period.The subjects were divided into Colorectal adenoma group,nonadenomatous colorectal polyp group(inflammatory or proliferative colorectal polyp)and healthy control group.Rate method is used to determine the serum Hcy levels between groups,and the serum CEA levels of groups were evaluated by electrochemical luminescence method.the differences of the levels of blood Hcy and CEA were compared.through depicting the ROC curve and comparing the area under the curve(AUC)value,the diagnosis value of the serum Hcy,CEA and Hcy combined with CEA for colorectal adenoma was analyzed.At the same time,the differences of serum Hcy levels in the colorectal adenoma group in different number,diameter size,adenoma distribution site and pathological histology were observed.SPSS22.0 software was used for statistical analysis for all data processing,and P<0.05 was considered statistically significant.Results1.There were no significant differences in age,gender,blood sugar,creatinine,BMI,AST,ALT,TC,TG,CRP among the three groups(P> 0.05).2.Serum Hcy levels in the colorectal adenoma group were(13.48±1.91)?mol/L,higher than that in the normal control group(10.72±1.28)?mol/L and that in the nonadenomatous colorectal polyp group(11.23±1.26)?mol/L(P < 0.01).While,the serum Hcy levels in the nonadenomatous colorectal polyp group were not significantly higher than that in the healthy control group(P > 0.05).The serum CEA levels of the colorectal adenoma group were(3.44±1.21)ng/ml,higher than that of the healthy control group(2.78±1.04)ng/ml and that of the nonadenomatous colorectal polyp group(2.81±1.03)ng/ml(P < 0.01).The serum CEA levels of the nonadenomatous colorectal polyp group were not significantly different from that of the healthy control group(P > 0.05).3.The AUC value of CEA in the diagnosis of colorectal adenoma was 0.659 and the optimal value was 3.51 ng/ml,with the accuracy of 31.8%,the sensitivity of 53.3% and the specificity of 80.0%.The AUC value of Hcy in the diagnosis of colorectal adenoma was 0.856,higher than that of CEA(P < 0.01).The optimal value was 11.83 mol/L,with the accuracy of 71.2%,the sensitivity of 80.8% and the specificity of 78.3%.The AUC value of Hcy combined with CEA in the diagnosis of colorectal adenoma was 0.873,higher than that of Hcy alone(P < 0.05)and CEA alone(P < 0.01),with the accuracy of 74.6%,the sensitivity of 86.7% and the specificity of 75.0%.4.Serum Hcy levels in the multiple colorectal adenomas group were(14.35±1.61)?mol/L,higher than that in the single group(12.34±1.66)?mol/L(P < 0.01).In the group with the maximum adenoma diameter 1cm,the serum Hcy levels were(14.05±1.83)?mol/L,higher than that in the group with the maximum adenoma diameter < 1cm(13.07±1.86)?mol/L(P < 0.01).serum Hcy levels in the villous adenoma group were(16.67± 0.93)?mol/L,higher than that in the tubular adenoma group(12.91±1.83)?mol/L and that in the villous tubular adenoma group(13.92±1.36)?mol/L(P < 0.01),while serum Hcy levels in the villous tubular adenoma group were higher than that in the tubular adenoma group(P < 0.05).Serum Hcy levels in the high-grade intraepithelial neoplasia group were(16.16±0.82)?mol/L,higher than that in the low-grade intraepithelial neoplasia group(13.01±1.63)?mol/L(P < 0.01).Serum Hcy levels in the distal large intestine group,proximal large intestine group and whole large intestine group were(13.30±1.93)?mol/L,(13.75±1.84)?mol/L,and(13.76±1.94)?mol/L,respectively,with no significant difference(P > 0.05).Conclusion1.Serum Hcy and CEA levels in the colorectal adenoma group were higher than those in the healthy control group and the nonadenomatous colorectal polyp group.2.Hcy has a certain diagnostic value for colorectal adenoma,which is higher than CEA;Hcy combined with CEA can improve diagnostic value for colorectal adenoma.3.Serum Hcy levels in colorectal adenoma group may be related to the number,diameter and histopathological type of adenoma(villous structure,high-grade intraepithelial neoplasia),but has nothing to do with the distubtion of adenomas. |
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