消化道恶性肿瘤患者FA、VitB<sub>12</sub> 、Fer及HCY的检测与预后分析

doi:10.16689/j.cnki.cn11-9349/r.2020.02.011

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摘要目的探讨贫血三项叶酸（FA）、维生素B12（VitB12）、铁蛋白（Fer）及同型半胱氨酸（HCY）对胃癌、结肠癌、肝癌患者预后生存的影响。方法选取2013年2月至2018年8月在黑龙江省农垦总局总医院暨黑龙江省第二肿瘤医院住院确诊为恶性肿瘤合并贫血的患者317例，包括胃癌113例，结肠癌120例，肝癌84例，分别进行贫血三项及HCY的检测，随访观察患者预后的情况，Cox风险比例模型分析贫血三项及HCY与患者预后的相关性，Kaplan-Meier法绘制生存曲线。结果 Cox风险比例模型多因素分析结果显示VitB12是胃癌贫血患者一个独立的预后因素（P=0.008）；FA、Fer和HCY的表达水平可作为结肠癌贫血患者的预后因素（P=0.01，P=0.001，P=0.002）；Fer和HCY可作为肝癌患者的预后因素（P=0.006，P=0.014）。Kaplan-Meier生存曲线分析显示，VitB12的水平对于Ⅰ、Ⅱ期胃癌贫血患者生存率无显著影响（P=0.174），而Ⅲ、Ⅳ期缺乏VitB12的胃癌贫血患者生存率显著低于VitB12正常的胃癌患者（P=0.043）。不论分期，缺乏FA及HCY升高的结肠癌患者预后生存率较差。肝癌组中，不论分期Fer和HCY明显升高的患者生存率显著降低。结论 FA、VitB12、Fer及HCY的水平与消化道恶性肿瘤贫血患者的预后显著相关，可作为消化道恶性肿瘤贫血患者的营养监测指标，辅助判断肿瘤患者的贫血程度及类型，完善肿瘤治疗方案，改善患者的预后。

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	周坤
	郑遵荣
	周玉珍

关键词 ： , 叶酸, 维生素B12, 铁蛋白, 同型半胱氨酸, 消化道恶性肿瘤

Abstract：Objective To investigate the effect of folic acid（FA）， vitamin B12 （VitB12）， ferritin（Fer） and homocysteine（HCY） on the prognosis and survival of gastric cancer， colon cancer and liver cancer patient. Methods From February 2013 to August 2018，a total of 317 patients diagnosed with malignant tumor complicated with anemia were selected from General Hospital of Heilongjiang Province Land Reclamation Bureau， including 113 cases of gastric cancer， 120 cases of colon cancer and 84 cases of liver cancer. Anemia indicators and HCY were detected in 317 patients respectively. Cox regression model was used to analyze the prognostic factors of patients， and Kaplan-Meier method was used to draw the survival curve. Results Multivariate Cox regression analysis showed that VitB12 was an independent prognostic factor in patients with gastric cancer anemia （P=0.008）； The expression level of FA， Fer and HCY can be used as prognostic factors for patients with colon cancer anemia （P=0.01， P=0.001， P=0.002）；Fer and HCY can be used as prognostic factors for patients with liver cancer （P=0.006， P=0.014）. Kaplan-Meier survival curve analysis showed that the level of VitB12 had no significant effect on the survival rate of patients with anemia of stage Ⅰ and Ⅱ gastric cancer （P=0.174）；Patients at stage Ⅲ and Ⅳ， the survival rate of patients lacking VitB12 was significantly lower than that of patients with normal VitB12（P=0.043）. Regardless of stage， the survival rate of colon cancer patients lack FA and HCY increased was poor. In the liver cancer group， survival rates were significantly reduced in patients with Fer and HCY increased，regardless of stage. Conclusion The levels of FA， VitB12， Fer and HCY are significantly correlated with the prognosis of patients with anemia of digestive tract malignant tumors. They can be used as nutritional monitoring indicators for patients with anemia of digestive tract malignant tumors， assisting in determine the anemia degree and type of patients， improving tumor treatment strategy and the prognosis.

Key words： Folic acid Vitamin B12 Ferritin Homocysteine Malignant tumors of the digestive tract

基金资助:黑龙江省农垦总局科技局科研项目（HNK125A-13-15）

通讯作者: 周坤，电子邮箱：zhoukunme_1111@163.com

引用本文:

周坤，郑遵荣，周玉珍. 消化道恶性肿瘤患者FA、VitB₁₂ 、Fer及HCY的检测与预后分析[J]. 肿瘤代谢与营养电子杂志, 2020, 7(2): 193-198.
Zhou Kun， Zheng Zunrong， Zhou Yuzhen. Correlation analysis of FA， VitB₁₂， Fer， HCY and prognosis in patients with malignant tumor of digestive system. Electron J Metab Nutr Cancer, 2020, 7(2): 193-198.

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