大肠癌患者手术前后血清CA199和癌胚抗原变化及其临床价值研究

Investigation on changes of serum CA199 and CEA levels in patients with colon cancer before and after operation andtheirclinicalvalue

目的探讨大肠癌患者手术前后血清肿瘤相关抗原199（canceranligen199，CAJ99）和癌胚抗原（CEA）变化及其临床价值。方法应用化学发光免疫分析法测定大肠癌患者术前和术后0～3个月血清CA199和CEA值，并对测定结果进行统计分析。结果（1）血清CA199和CEA在大肠癌根治术或姑息术术后表达水平均明显下降（P〈0．05），实行根治术的表达率显著下降（P〈0．05），而实行姑息术的表达率下降不明显（P〉0．05）。（2）血清CA199和CEA在大肠癌管状腺癌和黏液腺癌术后的表达水平均明显下降（P〈0．05），而乳突状腺癌下降不明显（P〉0．05）；管状腺癌术后的表达率明显下降（P〈0．05），乳突状腺癌术后的表达率下降不明显（P〉0．05），黏液腺癌术后仅CEA表达率有明显下降（P〈0．05）。（3）血清CA199和CEA在A期、B期大肠癌术后的表达水平和表达率均明显下降（P〈0．05），CA199在C期、D期术后表达水平和表达率的变化不同步，而CEA的变化则趋于一致；不同Dukes分期大肠癌CA199和CEA表达水平有显著差异（P〈0．05），二者表达水平随分期进展而上升，但表达率递增并不明显（P〉0．05）。（4）大肠癌术前CA199与CEA二者联合检测的敏感度显著高于CA199单项（P〈0．05），与CEA单项比较，虽敏感度有所上升，但幅度不明显（P〉0．05）；大肠癌术后CA199和CEA联检的敏感度与单项检测差异无统计学意义（P〉0．05）。结论大肠癌患者手术前后血清CA199和CEA的变化有一定的规律和特点，运用好这些规律和特点有助于判断临床分期、病理类型和选择恰当的手术方式；有助于评估手术效果和预测首程化疗疗效，为判断预后、及早发现术后复发患者提供参考依据。

Objective To investigate the changes of and their clinical value. Methods Chemiluminescent immunoassay was applied to measuring serum CA199 and CEA in patients with colon cancer before and after operation. Statistical analysis of the results was performed. Results （1） The levels of all declined after radical operation and palliation operation of colon cancer （P〈0.05）. The expression rates of serum CA199 and CEA after radical operation decreased significantly （P〈0.05）, while those after palliation operation didn＇t decrease （P〉0.05）. （2） The levels of serum CA199 and CEA of patients with tubular adenocareinoma and mueinous adenoeareinoma all decreased significantly after operation （P〈0.05）, but those with papillary adenoearcinoma didn＇t decrease （P〉0.05）. The expression rates of serum CA199 and CEA of patients with tubular adenoeareinoma decreased significantly （P〈0.05）, while those of patients with papillary adenoearcinoma didn＇t decrease （P〉0.05）. The levels of serum CEA of patients with mueinous adenocareinoma decreased markedly （P〈0.05）. （3） The levels and expression rates of serum CA199 as well as CEA of patients in stage A and stage B according to Dukes staging system all decreased significantly （P〈0.05）, but the change of levels and expression rates of those in stage C and D appeared unparallel, whereas as to CEA, those tended to be parallel. The levels of serum CA199 and CEA of patients in different Dukes stages were different from each other （P〈0.05）, and their levels increased with the Dukes stages, but their expression rates didn＇t increase （P〉0.05）. （4） The sensitivity of combined detection of CA199 and CEA was much higher than that of single CA199 detection. As compared with that of single CEA detection, the sensitivity of combined detection was elevated, but had no statistical significance （P〉0. 05）. Conclusion The changes of serum CA199 and CEA levels in colon cancer patients before and after operation have some regularity and characteristics. Elucidation of the regularity and characteristics is helpful for follows： judging clinical phases, pathology grouping and selecting suitable mode of operation; evaluating opera tion efficiency and predicting the efficiency of first course chemotherapy; providing reference for prognosis evaluation and early dignosis of recurrent cancer after operation.