摘要
目的 探讨血液系统肿瘤与实体肿瘤患者血清清蛋白(ALB)、乳酸脱氢酶(LDH)水平及肌酸激酶同工酶(CK-MB)/肌酸激酶(CK)比值差异及鉴别诊断价值。方法 选取该院2023年8月至2024年8月收治的228例恶性肿瘤患者作为研究对象,根据肿瘤类型分为实体肿瘤组(120例)与血液肿瘤组(108例),另选取同期在该院体检的114例健康志愿者作为对照组。比较3组血清ALB、LDH水平及CK-MB/CK比值,采用受试者工作特征(ROC)曲线分析ALB、LDH及CK-MB比值对实体肿瘤和血液系统肿瘤的鉴别诊断价值。危险度采用相对危险系数(RR)分析。结果 实体肿瘤组血清ALB、CK水平低于血液肿瘤组、对照组,血液肿瘤组血清ALB水平低于对照组,差异均有统计学意义(P<0.05);血液肿瘤组血清LDH水平高于实体肿瘤组、对照组,实体肿瘤组血清LDH水平高于对照组,差异均有统计学意义(P<0.05);实体肿瘤组CK-MB水平及CK-MB/CK比值高于血液肿瘤组、对照组,差异均有统计学意义(P<0.05);血液肿瘤组和对照组血清CK、CK-MB水平及CK-MB/CK比值比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示,血清ALB、LDH、CK-MB/CK比值鉴别诊断血液系统肿瘤与实体肿瘤的曲线下面积(AUC)分别为0.816、0.823、0.751。血清ALB、LDH、CK-MB/CK比值联合鉴别诊断血液系统肿瘤与实体肿瘤的AUC为0.917,大于血清ALB、LDH、CK-MB/CK比值单独鉴别诊断的AUC(Z=2.512、2.147、3.826,P=0.018、0.036、<0.001)。危险度分析结果显示,在血液系统肿瘤与实体肿瘤中,ALB<36.24 g/L、LDH<546.13 U/L时提示实体肿瘤的风险分别增加1.977倍、1.713倍(P<0.05),CK-MB/CK比值≥0.27时提示实体肿瘤的风险增加1.390倍(P<0.05)。结论 血液系统肿瘤与实体肿瘤患者血清ALB、LDH水平及CK-MB/CK比值存在显著差异,可作为临床鉴别诊断的血清学指标,且3项指标联合鉴别诊断更为可靠。
Objective To investigate the differences in serum albumin(ALB),lactate dehydrogenase(LDH)levels and the ratio of creatine kinase isoenzyme(CK-MB)/creatine kinase(CK)between patients with hematological malignancies and solid tumors,as well as their value in differential diagnosis.Methods A total of 228 patients with malignant tumors admitted to the hospital from August 2023 to August 2024 were selected as the research subjects and divided into the solid tumor group(120 cases)and the hematological tumor group(108 cases)according to the tumor types.Additionally,114 healthy volunteers who underwent physical examinations in the hospital during the same period were selected as the control group.The levels of serum ALB and LDH and the ratio of CK-MB/CK in the 3 groups were compared.The receiver operating characteristic(ROC)curve was used to analyze the value of differential diagnosis for solid tumors and hematological tumors.The degree of risk was analyzed using the relative risk coefficient(RR).Results The levels of serum ALB and CK in the solid tumor group were lower than those in the hematological tumor group and the control group,and the level of serum ALB in the hematological tumor group was lower than that in the control group,and the differences were statistically significant(P<0.05).The serum LDH level in the hematological tumor group was higher than that in the solid tumor group and the control group,and the serum LDH level in the solid tumor group was higher than that in the control group,and the differences were statistically significant(P<0.05).The level of CK-MB and the CK-MB/CK ratio in the solid tumor group were higher than those in the hematological tumor group and the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the levels of serum CK and CK-MB and the CK-MB/CK ratio between the hematological malignancies group and the control group(P>0.05).The results of ROC curve analysis showed that the areas under the curve(AUC)of serum ALB,LDH,and CK-MB/CK ratio in the differential diagnosis of hematological tumors and solid tumors were 0.816,0.823,and 0.751 respectively.The AUC of the combined differential diagnosis of hematological tumors and solid tumors by serum ALB,LDH and CK-MB/CK ratio was 0.917,which was greater than that of the differential diagnosis by serum ALB,LDH and CK-MB/CK ratio alone(Z=2.512,2.147,3.826,P=0.018,0.036,<0.001).The results of risk analysis showed that in hematological malignancies and solid tumors,when ALB<36.24 g/L and LDH<546.13 U/L,the risk of solid tumors increased by 1.977 times and 1.713 times respectively,and when the CK-MB/CK ratio≥0.27,the risk of solid tumors increased by 1.390 times(P<0.05).Conclusion There are significant differences in the levels of serum ALB and LDH and the CK-MB/CK ratio between patients with hematological tumors and those with solid tumors.These can be used as serological indicators for clinical differential diagnosis,and the combined differential diagnosis of the three indicators is more reliable.
作者
陈亚楠
王丽芳
李美霞
褚娜利
单海霞
CHEN Ya′nan;WANG Lifang;LI Meixia;CHU Nali;SHAN Haixia(Department of Laboratory Diagnosis,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou,Hebei 061000,China;Department of Clinical Laboratory,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou,Hebei 061000,China)
出处
《检验医学与临床》
2025年第15期2078-2083,共6页
Laboratory Medicine and Clinic
基金
2022年河北省沧州市科技计划自筹经费项目(222106135)。
关键词
血液系统肿瘤
实体肿瘤
乳酸脱氢酶
肌酸激酶同工酶
肌酸激酶
诊断价值
hematological malignancy
solid tumor
lactate dehydrogenase
creatine kinase isoenzyme
creatine kinase
diagnostic value
