多项肿瘤标志物联合检测对肝癌早期诊断的作用

Clinical significance of multi-tumor markers detection in the early diagnosis of hepatocellular carcinoma

目的探讨多项肿瘤标志物联合检测在原发性肝癌中的诊断价值及建立判别方程。方法采用蛋白芯片技术，检测2003年11月至2006年4月大坪医院收治的98例原发性肝癌患者（肝癌组）、67例良性肝病患者（肝病组）、46例健康体检者（对照组）血清中的12项肿瘤标志物，并在肝癌组与肝病组患者之间建立判别方程。采用方差分析和Χ^2检验对检测结果进行分析。结果肝癌组中87例患者肿瘤标志物呈阳性表达（89％），肝病组中有13例呈阳性表达（19％），对照组中有2例呈阳性表达（4％）。3组中的AFP、CEA、铁蛋白、CA19-9和CA125检测结果比较，差异有统计学意义（F=59．530，40．472，31．708，75．897，153．066，P〈0．05）。联合检测这5项指标，肝癌临床诊断符合率提高为89％，明显高于单项AFP检测的64％（Χ^2=16．362，P〈0．05）。所建判别方程的判断准确率为90％。结论多项肿瘤标志物联合检测优于单独AFP检测，可用于对肝癌高危人群的筛查及原发性肝癌的早期诊断。

Objective To investigate the value of combined detection of multi-tumor markers in the diagnosis of primary hepatocellular carcinoma （HCC） and to establish the discriminant equation. Methods Using a protein chip, 12 tumor markers in the serum from 98 patients with HCC and 67 patients with benign liver disease who had been admitted to Daping Hospital from November 2003 to April 2006, and 46 healthy individuals during the same period were analyzed. A discriminant equation was established to discriminate primary HCC from benign liver diseases. All the data were processed by variance analysis and chi-square test. Results The positive rates of the tumor markers were 89% （87/98） in patients with primary HCC, 19% （13/67） in patients with benign liver disease and 4% （ 2/46 ） in healthy individuals. There was statistical difference in the serum level of alpha-fetoprotein （AFP）, carcinoembryonic antigen （CEA）, ferritin （FER）, CA19-9 and CA125 among the 3 groups （ F = 59.530, 40.472, 31. 708, 75. 897, 153. 066, P 〈0.05）. Combined detection of AFP, CEA, FER, CA19-9 and CA125 improved the diagnostic accordance rate to 89% , which was significantly higher than the diagnostic accordance rate （64%） when only AFP was detected （ Χ^2 = 16. 362, P 〈 0.05 ）. The accuracy of the discriminant equation was 90%. Conclusions Combined detection of multi-tumor markers is superior to AFP detection. Combined detection of multi-tumor markers can be used in screening of the HCC patients in HCC high risk population and in the early diagnosis of primary HCC.