用积分法评价6项血清肿瘤标志物对原发性肝癌的诊断价值

The value of integral method with the six tumor markers in the diagnosis of primary hepatic cancer

目的探讨用积分法评价血清甲胎蛋白（AFP）、α-L-岩藻糖苷酶（AFU）、糖类抗原CA199、CA153、CA125和铁蛋白（FER）等6项肿瘤标志物对原发性肝癌（PHC）的诊断价值。方法采用免疫化学发光法、自动生化分析仪连续监测法分别检测92例PHC患者、15例转移性肝癌患者、49例良性肝病患者和72名正常对照者血清中的AFP、AFU、CA199、CA153、CA125、FER，根据这些肿瘤标志物单项诊断PHC的有效性分别积分为5，5，4，3，3，2分，计算总积分。用总积分评价6项肿瘤标志物对PHC诊断的临床应用价值，并与PHC的TNM分期进行相关性分析。结果单项指标诊断PHC的灵敏度在51．1％～72．8％间，特异性在75．0％～98．6％，有效性在66．5％～79．3％间，积分法诊断PHC的灵敏度为89．1％，特异性为93．1％，诊断有效性90．9％。总积分水平与PHC患者的TNM分期呈显著正相关（r=0．65，P〈0．001）。结论在对PHC患者用AFP、AFU、CA199、CA153、CA125和FER进行组合检查时，用积分法评价可显著提高对PHC的诊断价值。

Objective To evaluate the clinical value of integral method with alphafetoprotein （AFP） ,alpha-L-Fucosidase （AFU）,CA199,CA153,CA125,Ferritin（FER） in the diagnosis of primary hepatic cancer（PHC）.Methods AFP,CA199, CA153,CA125 and FER were measured by chemiluminescence immunoaasay with the use of ACS： 180 analyzer. AFU was detected by kinetic rate assay with LX20 analyzer.72 patiants with primary beptic cancer and 15 with hepatic metastasis of gastrointestinal and lung cancer, 49 patiens with benign liver diseases and 72 Healthy adults were studied.AFP, AFU, CA199,CA153,CA125,FER were integrated 5,5,4,3,3,2 respectively according the utility of single tumor marker in the diagnosis of PHC. The clinical diagnosis value was evaluated by integral method. Rank correlation analysis was used to assess the relation between value of integration and TNM stage.Remits The sensitivity of single tumor maker in the diagnosis of PHC was between 51.1% - 72.8% ; their specificity was between 75.0% - 98.6% ;the diagnostic utility was between 66. 5 % - 79.3 %. In the integrated method, the sensitivity and specificity were 89.1% and 93.1% respectively; the utility was 90.9% in the diagnosis of PHC. The integral level of a six tumor markers was correlated with TNM stage. Conclusion The utility can be increased with the integrated mthod of AFP, AFU, CA199,CA153,CA125, FER in the diagnosis of PHC.