Expression And Significance Of Serum Homocysteine In Patients With Colorectal Polyps And Colorectal Cancer

Objective:Comparing the changes of serum homocysteine(Hcy),methionine(Met)and cysteine(Cys)levels in patients with colorectal polyps,patients with colorectal cancer(CRC)and healthy people to observe the correlation between Hcy,Met and Cys which are the metabolites of Hcy,and the occurrence of colorectal diseases.Then explore whether Hcy can be used as a new serological marker for the diagnosis of colorectal diseases and if the combination of Hcy and other serological markers can establish a more efficient diagnostic method for CRC.Methods: We collected a total of 438 caces who first visited to the Second Hospital of Dalian Medical University from October 2018 to October 2020 in this study.These people were divided into 3 groups: 122 cases of healthy control group,169 cases of colorectal polyp groups(62 cases of patients with inflammatory polyps or hyperplastic polyps,107 cases of patients with adenomas),and 147 cases of CRC groups(26 cases in stage I,57 cases in stage II,49 cases in stage Ⅲ,15 cases in stage Ⅳ).Collected and using SPSS26.0 software to compare the levels of serum Hcy,Cys,Met,tumor markers,age,gender ratio,body mass index(BMI),cholesterol(TC),triglycerides(TG),blood creatinine(Cr),aspartate aminotransferase(AST),alanine aminotransferase(ALT),total fasting blood glucose(FBG).Then statistically analyzed the differences to observe the correlation between the occurrence of colorectal polyps,colerectal cancer as well as the staging of CRC and serum Hcy levels.Drew the ROC curve of Hcy for the diagnosis of colorectal diseases by using Med Calc 19.6.1 software,and explored it’s reference value in the diagnosis of colorectal diseases.Results:1.There were no statistical differences in levels of FBG,TC,TG,Cr,AST,ALT,age,gender ratio,and BMI among healthy individiuals,patients with colorectal polyps and patients with CRC.2.Among healthy individiuals,colorectal polyps patients,and CRC patients,a gradual rising trend in levels of serum Hcy could be seen and the differences were statistically significant(all P values < 0.001)in pairwise comparison.The similiar rising trend also appeared among the 7 subgroups of healthy individiuals,non-adenoma patients,adenoma patients,and CRC patients in stage I-IV.The serum Hcy level of the healthy individiuals was lower than those of non-adenoma petients,adenoma patients and CRC patients in stage I-IV(all P values <0.05);the serum Hcy levels of the non-adenoma patients and adenoma patients were lower than those of CRC patients in stage II-IV(all P values <0.05);the serum Hcy level of CRC patients in stage IV was higher than those of I-III(all P values <0.001),and no statistically difference was found among the remaining subgroups.However,no statistically differences were found in serum Cys and Met levels among healthy individiuals,colorectal polyps patients,and CRC patients.3.There were statistically significant differences in serum CEA,CA199,and CA242 levels among healthy individiuals,colorectal polyps patients,and CRC patients.All of the levels of above serum markers in CRC patients were higher than those of healthy individiuals and colorectal polyps patients(all P values<0.05).4.In the Spearman correlation analysis,we found that only Hcy was positively correlated with the occurrence of colorectal polyps;Hcy,Cys,CEA,CA199,CA242 were positively correlated with the occurrence of CRC;Hcy,CEA,CA199,CA242 were positively correlated with the stages of CRC.5.In binary logistic regression analysis,it was found that Hcy was an independent risk factor for colorectal polyps,and Hcy,CEA,and CA242 were independent risk factors for CRC.6.By drawing the ROC curves of various indicators for the diagnosis of colorectal polyps and CRC,it was found that serum Hcy has a reference value for the diagnosis of colorectal polyps,and the AUC value is 0.635.Serum Hcy,CEA,CA242 and CA199 have diagnostic value for CRC,and the AUC values are 0.702,0.798,0.654,0.611,respectively.The diagnostic efficiency of serum CEA was higher than that of serum Hcy,CA242 and CA199(all P values <0.01),and the diagnostic efficiency of serum Hcy and CA242 was higher than that of CA199(all P values <0.05).No statistical difference in the diagnostic efficiency was found between serum CA242 and Hcy(P>0.05).When testing two of them together,the highest AUC value for the evaluation of serum CEA and Hcy was 0.837;when testing three of them together,the highest AUC value for evaluation of serum CEA,Hcy and CA242 was 0.840;the AUC value of combined evaluation of serum CEA,Hcy,CA242 and CA199 was 0.839,all of them were better than testing CEA alone(P<0.05).However,there was no statistical difference between the combined evaluation of serum CEA,Hcy,CA242 and the combined evaluation of serum CEA,Hcy(P>0.05).Conclusion:1.There is a gradual upward trend of serum Hcy levels in healthy people,colorectal polyps and CRC patients;2.The increase of serum Hcy level is positively correlated with the occurrence of colorectal polyps,CRC,and the staging of CRC.It is an independent risk factor for colorectal polyps and CRC.3.Serum Hcy has a reference value for the diagnosis of colorectal polyps and CRC.Considering the detection cost and diagnostic efficiency,it is suggested that taking the combined test of serum Hcy and CEA to screen and diagnose CRC in clinic.