上消化道恶性肿瘤患者血清多项肿瘤标志物联合检测的临床意义

Clinical significance of combined detection of serum levels of multiterm tumor markers in patients with upper gastrointestinal cancer

目的评价癌胚抗原（CEA）、唾液酸化岩藻戊糖（CA19—9）、胃肠道癌抗原（CA242）、甲胎蛋白（AFP）、胃癌及卵巢癌抗原（CA724）、鳞状上皮细胞癌抗原（SCC）、组织多肽抗原（TPA）、细胞角蛋白（TPS）8项标志物联合检测，对上消化道恶性肿瘤的临床诊断、评价疗效及预后等方面的临床意义。方法对373例上消化道恶性肿瘤患者及50名健康体检者血清标本进行8项标志物检测，评价标志物水平与病情的关系。结果8项标志物诊断阳性率分别为：CEA26．80％，CA19—927．34％，CA24234．14％，AFP2．84％，SCC19．72％，CA72412．13％，TPA34．15％，TPS30．89％。8项标志物联合检查的总阳性率为89．05％。术前CEA、CA242、SCC阳性患者的生存时间较短。上消化道恶性肿瘤患者血清CA242和CA19—9水平呈密切的正相关。结论多项标志物联合检测在上消化道恶性肿瘤不同病理分型及临床分期中差异有统计学意义，且阳性率远高于任何标志物单独检测的结果。CA19—9与CA242可能成为监测病情的最佳组合。CA724、CA242和SCC3项标志物可分别作为贲门、胃、食管恶性肿瘤患者的不良预后指标。

Objective To evaluate clinical significance of the CEA, CA19-9, CA242, AFP, CA724, SCC, TPA, TPS combined detection for the clinical diagnosis of gastrointestinal cancer. Methods 373 cases of upper digestive tract malignant tumor patient and 50 cases of healthy serum sample were detected for eight markers, evaluating the relationship between the level of markers and illness. Results 8 marker diagnostic positive rates were： CEA 26.80 %, CA19-9 27.34 %, CA242 34.14 %, AFP 2.84 %, SCC 19.72 %, CA724 12.13 %, TPA 34.15 %, TPS 30.89 %. The total positive rate of joint detection of 8 markers was 89.05 %. Preoperative CEA, CA242, SCC-positive patients had a shorter survival time. CA242 and CA19-9 levels with upper gastrointestinal malignancies were positively correlated. Conclusion The combined detection of a number of markers in different pathological type and clinical staging is statistically significant, and the positive rate is much higher than any single marker test results. CA19-9 and CA242 may be the best combination of monitoring the disease. CA724, CA242 and SCC can be as adverse prognostic indicators for cardia, stomach, esophageal malignant tumors, respectively.