文章摘要
血清CBLL1、ADAMTS13、CHI3L1水平与结直肠癌患者与化疗心脏毒性的关系及预后评估价值
The relationship between serum CBLL1, ADAMTS13, CHI3L1 levels with chemotherapy-induced cardiac toxicity in colorectal cancer patients and their prognostic evaluation value
投稿时间：2025-10-15  修订日期：2026-04-01
DOI：
中文关键词: 结直肠癌  E3泛素连接酶  血管性血友病因子裂解蛋白酶13  几丁质酶-3样蛋白1  心脏毒性
英文关键词: Colorectal cancer  Casitas B lineage lymphoma  A disintegrin like and metalloproteinase with thrombospondin type Ⅰ motif 13  Chitinase-3-like protein 1  Cardiac toxicity
基金项目:河北省健康委员会自助项目,编号:20261382
作者单位邮编
贾向博* 石家庄市第二医院 050051
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中文摘要:
      目的:分析血清E3泛素连接酶(CBLL1)、血管性血友病因子裂解蛋白酶13(ADAMTS13)、几丁质酶-3样蛋白1(CHI3L1)水平与结直肠癌患者与化疗心脏毒性的关系及预后评估价值。方法:选取石家庄市第二医院于2020年2月至2022年4月收治的结直肠癌患者153例(病例组),根据患者是否发生化疗相关心脏毒性事件分为发生组(35例)与未发生组(118例)；根据患者的预后情况分为良好组(109例)、不良组(44例)。另选取同期80例结直肠良性病变患者作为对照组。ELISA法检测血清CBLL1、ADAMTS13、CHI3L1水平；相对危险度分析对结直肠癌患者预后的影响；ROC曲线评估血清CBLL1、ADAMTS13、CHI3L1对结直肠癌患者预后不良的预测价值；决策曲线评估血清CBLL1、ADAMTS13、CHI3L1预测模型的临床净效益率。结果:与对照组相比,病例组血清CBLL1、CHI3L1水平升高,ADAMTS13水平降低(P<0.05)；与未发生组相比,发生组血清CBLL1、CHI3L1水平升高,ADAMTS13水平降低(P<0.05)；与良好组相比,不良组血清CBLL1、CHI3L1、CEA、CA199水平及淋巴结转移、低分化患者占比升高,ADAMTS13水平降低(P<0.05)；血清CBLL1、CHI3L1高水平患者发生预后不良风险是低水平患者的2.176倍、2.007倍,血清ADAMTS13低水平患者发生预后不良风险是高水平患者的2.060倍(P<0.05)；血清CBLL1、ADAMTS13、CHI3L1单独及联合预测结直肠癌患者预后不良的曲线下面积(AUC)分别为0.813、0.799、0.815、0.932,三者联合预测效能较优(Z=3.818、3.967、3.949,P<0.05)；高风险阈值在0.06~0.92时,血清CBLL1、ADAMTS13、CHI3L1联合预测模型的净效益率高于单一指标。结论:结直肠癌患者血清CBLL1、CHI3L1水平升高,ADAMTS13水平降低,与发生化疗心脏毒性有关,或可作为评估结直肠癌患者预后不良的生物学指标。
英文摘要:
      Objective: To analyze the relationship between serum casitas B lineage lymphoma (CBLL1), a disintegrin like and metalloproteinase with thrombospondin type Ⅰ motif 13 (ADAMTS13), chitinase-3-like protein 1 (CHI3L1) levels with chemotherapy-induced cardiac toxicity in colorectal cancer patients, as well as their prognostic evaluation value. Methods: From February 2020 to April 2022, 153 colorectal cancer patients (case group) admitted to our hospital were selected. Patients were assigned into occurrence group (35 cases) and non occurrence group (118 cases) based on whether they experienced chemotherapy-induced cardiac toxicity events; and according to the prognosis of the patients, they were assigned into good group (109 cases) and adverse group (44 cases). Another 80 patients with benign colorectal lesions were served as the control group. ELISA method was used to detect levels of serum CBLL1, ADAMTS13, and CHI3L1. Relative risk was used to discuss the impact on the prognosis of colorectal cancer patients. ROC curve was used to evaluate the predictive value of serum CBLL1, ADAMTS13, and CHI3L1 for adverse prognosis in colorectal cancer patients. In addition, the decision curve was used to evaluate the clinical net benefit of the serum CBLL1, ADAMTS13, and CHI3L1 prediction models. Results: Compared with the control group, the case group had higher levels of serum CBLL1 and CHI3L1, and a lower level of ADAMTS13 (P<0.05). Compared with the non occurrence group, the occurrence group had higher levels of serum CBLL1 and CHI3L1, and a lower level of ADAMTS13 (P<0.05). Compared with the good group, the adverse group had higher levels of serum CBLL1, CHI3L1, CEA, CA199, as well as higher proportions of lymph node metastasis and low differentiation, and a lower level of ADAMTS13 (P<0.05). The risk of adverse prognosis in patients with high levels of serum CBLL1 and CHI3L1 was 2.176 times and 2.007 times higher than that in patients with low levels, the risk of adverse prognosis in patients with a low level of serum ADAMTS13 was 2.060 times higher than that in patients with high level (P<0.05). The area under the curve (AUC) values for predicting adverse prognosis in colorectal cancer patients using serum CBLL1, ADAMTS13, and CHI3L1 alone and their combination were 0.813, 0.799, 0.815, and 0.932, respectively, moreover, the combined predictive power was better (Z=3.818, 3.967, 3.949, P<0.05). When the high-risk threshold was between 0.06 and 0.92, the net benefit rate of the combined prediction model of serum CBLL1, ADAMTS13, and CHI3L1 was higher than that of a single indicator. Conclusion: Serum CBLL1 and CHI3L1 are elevated in patients with colorectal cancer, while ADAMTS13 level is decreased. They are associated with chemotherapy-induced cardiac toxicity and may serve as biological indicators for evaluating adverse prognosis in colorectal cancer patients.
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