|
【摘要】 目的： 探讨AFP(甲胎蛋白)、CEA(癌胚抗原)、CA125(糖链抗原CA125)、CA199(糖链抗原CA199)等四种肿瘤标志物在原发性肝癌(primary hepatic cancer，PHC)辅助诊断中的应用价值，为临床应用中选择优化合理、经济实用的肿瘤标志物组合提供参考依据。方法：以化学发光标记免疫法测定原发性肝癌组40例、肝脏良性疾病组55例、正常对照组52例中AFP、CEA、CA125、CA199的含量，比较四种肿瘤标志物单独或联合检测对原发性肝癌诊断的敏感性和准确性。结果:PHC组中血清AFP、CEA、CA125、CA199含量显著高于良性肝病组及正常对照组(P<0.05)。4种肿瘤标志物的联检阳性率为85.0%，显著高于良性肝病组(40.0%)和正常对照组(5.7%)(P均<0.01);联合检测在提高PHC诊断敏感性(P<0.05)的同时，特异性有所下降(P<0.05)。结论:肿瘤标志物AFP、CEA、CA125、CA199联合检测可提高诊断PHC的阳性诊断率，四种肿瘤标志物联检对PHC有十分重要的诊断价值。 【关键词】 肿瘤，肝;肿瘤标记,生物学;电化学发光免疫分析;血清标志物 作者：汤钦枞，魏祥坤 作者单位：厦门市第三医院，福建 厦门 316000 TANG Qincong， WEI Xiangkun(The Third Hospital of Xiamen, Xiamen 31600, China)[ABSTRACT] Objective: To explore the value of four tumor markers including AFP (alpha fetoprotein), CEA, CA125, and CA199 in the diagnosis of primary hepatic cancer in order to find evidence for choosing optimized detection of tumor markers. Methods: Chemiluminescence immunoassay method was applied to detecte the AFP, CEA, CA125, CA199 levels in 40 cases of primary liver cancer, 55 cases of benign liver disease, and 52 normal controls in order to investigate the sensitivity and accuracy of the four tumor markers (alone or combined detected) in the diagnosis of primary liver cancer. Results: Serum AFP, CEA, CA125 and CA199 levels of primary liver cancer cases were significant higher than that of the benign liver disease cases and normal controls (P<0.05). Joint detection of the four tumor markers showed a positive rate of 85.0% in primary liver cancer cases, significant higher than that in benign liver disease cases (40.0%) and normal controls (5.7%) (P all <0.01). Joint detection of the four tumor markers improved the diagnostic sensitivity (P< 0.05), while decreased the specificity at the same time(P <0.05). Conclusion: Joint detection of four tumor markers including AFP, CEA, CA125 and CA199 can improve diagnosis accuracy of primary liver cancer with significant diagnostic value. [KEY WORDS] Tumor, liver; Tumor marker; Biology; Chemiluminescence immunoassay; Serum markers 原发性肝癌(primary hepatic cancer， PHC)为我国常见的恶性肿瘤之一，可发生于任何年龄，男女之比为(3～5)∶1，死亡率在恶性肿瘤中列第三位[1]。其诊断主要依据超声、CT及病理检查等。甲胎蛋白(AFP)多年来被作为初筛诊断PHC的首选指标，但有20%～40%的PHC患者AFP阴性或低值[2]。因此，本文采用电化学发光免疫分析技术联合检测甲胎蛋白(AFP)、癌胚抗原(CEA)、糖原125(CA125)、糖原199(CA199)等四项指标，探讨其对原发性肝癌诊断的价值。 1 资料与方法 1.1 一般资料 2008年4月～2009年4月我院收治肝癌住院患者75例，选取其中原发性肝癌患者40例为PHC组，其中男性31例，女性9例。诊断依据病理学、影像学、肿瘤标志物联合检查，并结合病史和临床表现。良性肝病组55例，其中肝硬化12例，肝炎43例，男性35例，女性20例，平均41.5岁;正常对照组52例，均为门诊健康查体者，其中男性36例，女性16例，平均38.7岁。 1.2 方法 1.2.1 样品的采集 所有研究对象均于早晨空腹静脉采血3 mL，离心分离血清，立刻检测。 |