多项肿瘤标志物联合检测在卵巢疾病诊断中的作用

Value of combined multiple tumor markers in the differential diagnosis of benign and malignant ovarian diseases

目的探讨肿瘤标志物CA125、CA199和癌胚抗原(CEA)在卵巢疾病诊断中的应用价值。方法将146例在术前行肿瘤标志物联合检测的患者按不同疾病类型进行分类,比较分析检测值和阳性率。结果恶性肿瘤组CA125与CA199联合检测及3项联合检测的阳性率均为87.50%,显著高于良性疾病及CA199(43.75%)单项检测的阳性率(P<0.01或<0.05)。良性疾病中,卵巢内膜样囊肿患者单项CA125和CA199的阳性率升高,与卵巢恶性肿瘤组差异无显著性(P>0.05)。但卵巢恶性肿瘤患者CA125和CA199的检测值均高于卵巢内膜样囊肿组(P<0.05)。CA125>65U/ml时,卵巢恶性肿瘤组的灵敏度为59.38%、特异度为91.23%、阳性预测值为65.52%、阴性预测值为88.89%,均明显高于卵巢内膜样囊肿组(P<0.01或<0.05)。而37.5U/ml≤CA125≤65U/ml时,卵巢内膜样囊肿的灵敏度为41.86%、阳性预测值为56.25%,亦明显高于卵巢恶性肿瘤组(P<0.01或<0.05)。结论肿瘤标志物联合检测可提高卵巢肿瘤良、恶性鉴别的准确性。CA125以65U/ml作为临界值更有助于区分卵巢恶性肿瘤与卵巢内膜样囊肿。

Objective To appraise the value of tumor markers CA125 ,CA19-9 and CEA in the differential diagnosis of benign and malignant ovarian diseases. Methods 116 patients were tested with combined multiple tumor markers preoperatively and were categorized into various groups of ovarian diseases. The detected value and the positive rates were analyzed. Results The positive rates of the malignant ovarian tumors （87.50%） were higher than those of the benign disease（P-〈0.05）. Among the benign disease group, the positive rates of CA125 and CA19-9 in the ovarian endometriotic cyst were higher but there was no statistical difference between the malig nant ovarian tumor and the ovarian endometriotie cysts. In ease of CA125〉65 U/ml, the sensitivity of CA125 in malignant ovarian tumor group was 59.38%, the specificity 91. 23%, the positive predieitive value （65.52%） and the negative predicitive value 88.89%; higher than those in the ovarian endometriotic cyst group, the difference was signifieant（P〈0.05）. In case of CA125 was at the range of 37.5-65 U/ml , the sensitivity of CA125 in the ovarian endometriotic cyst was 41.86% and the positive predicitive value 56.25%; higher than those in the malignant ovarian tumor group（P〈0.01 or 〈0.05）. Conclusions The accuracy of distinguishing the malignant from henign ovarian tumor is enhanced by combined multiple tumor markers testing. CA125 is useful for distinguishing the malignant ovarian tumor from the ovarian endometriotic cyst. （Shanghai Med J, 2006,29 ： 19-21 ）