结直肠癌患者腹腔镜术后血清淀粉样蛋白A和可溶性CD14亚型的表达水平及其对早期吻合口瘘的预测价值

The expression levels of serum SAA and Presepsin in patients with colorectal cancer after laparoscopic surgery and their predictive value for early anastomotic leakage

摘要:

目的 探讨结直肠癌患者腹腔镜术后血清淀粉样蛋白A（SAA）和可溶性CD14亚型（Presepsin）的表达水平及其对早期吻合口瘘的预测价值。方法 选取2021年10月－2024年4月该院收治的结直肠癌患者126例，依据患者腹腔镜术后3 d内是否发生吻合口瘘，将患者分为未发生吻合口瘘组（对照组，n = 103）和发生吻合口瘘组（观察组，n = 23）。采用酶联免疫吸附试验（ELISA）检测两组患者术后血清Presepsin和SAA表达水平；采用Pearson法，探讨结直肠癌患者腹腔镜术后血清Presepsin和SAA表达水平的相关性；采用多因素Logistic回归模型，分析影响结直肠癌患者腹腔镜术后发生早期吻合口瘘的独立危险因素；绘制受试者操作特征曲线（ROC curve），评估结直肠癌患者腹腔镜术后血清Presepsin和SAA表达水平对早期吻合口瘘的预测价值。结果 与对照组比较，观察组肿瘤距肛门距离≥7 cm患者比例明显减少，术中出血量明显增加，差异均有统计学意义（P < 0.05）；观察组术后血清Presepsin和SAA表达水平明显高于对照组，差异均有统计学意义（P < 0.05）。结直肠癌患者腹腔镜术后血清Presepsin和SAA表达水平呈正相关（r = 0.749，P = 0.016）；血清Presepsin高于389.23 pg/mL和SAA表达水平高于25.10 mg/L，是影响结直肠癌患者腹腔镜术后发生早期吻合口瘘的独立危险因素，肿瘤距肛门距离≥7 cm为保护因素。血清Presepsin和SAA单独检测，以及联合检测，预测结直肠癌患者腹腔镜术后发生早期吻合口瘘的曲线下面积（AUC）分别为：0.834（95%CI：0.757～0.894）、0.801（95%CI：0.720～0.866）和0.897（95%CI：0.830～0.944），联合检测优于血清Presepsin和SAA单独检测（Z_{两者联合-Presepsin} = 2.085、Z_{两者联合-SAA} = 2.010，均P < 0.05）。结论 结直肠癌患者腹腔镜术后血清Presepsin和SAA表达水平升高，两者联合检测对早期吻合口瘘具有较高的预测价值。

Abstract:

Objective To investigate the levels of serum soluble CD14 subtype (Presepsin) and serum amyloid protein A (SAA) in patients with colorectal cancer after laparoscopic surgery, and their predictive value for early anastomotic leakage.Methods From October 2021 to April 2024, 126 patients with laparoscopic colorectal cancer were divided into the non-anastomotic leakage group (control group, n = 103) and the anastomotic leakage group (observation group, n = 23) based on whether anastomotic leakage occurred within 3 days after the operation. Clinical information was collected from both groups and compared between groups. Enzyme linked immunosorbent assay (ELISA) was applied to detect the postoperative serum levels of Presepsin and SAA in two groups. Pearson method was applied to investigate the correlation between postoperative serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery. The multivariate Logistic regression model was applied to analyze the key factors influencing the occurrence of anastomotic leakage in the early postoperative period in patients with colorectal cancer after laparoscopic surgery. The receiver operating characteristic curve (ROC curve) was applied to evaluate the predictive value of serum Presepsin and SAA levels for early anastomotic leakage in colorectal cancer patients after laparoscopic surgery.Results Compared with the control group, the proportion of patients with tumours ≥ 7 cm from the anus was significantly reduced and intraoperative bleeding was significantly increased in the observation group, the differences were statistically significant (P < 0.05). The postoperative levels of serum Presepsin and SAA in the observation group were obviously higher than those in the control group, the differences were statistically significant (P < 0.05). There was an obvious positive correlation between serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery (r = 0.749, P = 0.016). Serum Presepsin levels higher than 389.23 pg/mL and SAA expression levels higher than 25.10 mg/L were independent risk factors for the occurrence of early anastomotic leakage after surgery in patients with colorectal cancer after laparoscopic surgery. A tumor distance from the anus of ≥ 7 cm was a protective factor. The area under the curve (AUC) of serum Presepsin and SAA alone and in combination for detecting early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery was 0.834 (95%CI: 0.757~0.894), 0.801 (95%CI: 0.720 ~ 0.866), and 0.897 (95%CI: 0.830 ~ 0.944). The combined detection was superior to the separate detection of Presepsin and SAA (Z_{combination-Presepsin} = 2.085, Z_{combination-SAA} = 2.010, both P < 0.05).Conclusion Serum levels of Presepsin and SAA are elevated in patients with colorectal cancer after laparoscopic surgery, and their combined detection has high predictive value for early anastomotic leakage.