胆管癌患者血清和胆汁癌胚抗原与糖类抗原242的测定及其临床意义

Determination and clinical significance of serum and bile carcinoembryonic antigen and carbohydrate antigen 242 in cholangiocarcinoma patients

目的探讨单独和联合检测血清和胆汁癌胚抗原(CEA)与糖类抗原242(CA242)水平对胆管癌的诊断价值。方法采用电化学发光法和酶联免疫吸附剂测定法分别检测30例胆管癌患者和11例胆管良性狭窄患者血清和胆汁CEA与CA242水平。结果血清CEA诊断胆管癌的敏感度和特异度分别为56.7%与63.6%,血清CA242诊断胆管癌的敏感度和特异度分别为80.0%与81.8%;胆汁CEA诊断胆管癌的敏感度和特异度分别为66.7%与72.7%,胆汁CA242诊断胆管癌的敏感度和特异度分别为46.7%与63.6%;血清CA242与胆汁CEA两者联合检查诊断胆管癌的敏感度和特异度分别为53.4%与95.0%。受试者工作特征曲线显示血清CEA与CA242曲线下面积分别为0.570 (P>0.05)和0.856(P<0.01),胆汁CEA与CA242曲线下面积分别为0.759(P<0.01)和0.491(P>0.05)。结论血清CA242和胆汁CEA单独诊断胆管癌敏感度和特异度均较好,可作为临床诊断胆管癌的肿瘤标志物;血清CEA和胆汁CA242对临床诊断胆管癌无应用价值;血清CA242和胆汁CEA联合检查明显提高了诊断胆管癌的特异度,但敏感度有所下降。

Objective To investigate the diagnostic value of individual or combinative determi- nation of serum as well as bile carcinoembryonic antigen （CEA） and carbohydrate antigen 242 （CA242） to cholangiocarcinoma. Methods Electrochemical luminescent technique and enzymelinked immunosorbent assay were used to determine serum as well as bile CEA and CA242 in 30 cases of cholangiocarcinoma and 11 cases of benign biliary duct stricture. Results Out of 41 cases, the sensitivity and specificity of serum CEA were 56.7% and 63.6% respectively while the sensitivity and specificity of serum CA242 were 80.0% and 81.8% respectively. The sensitivity and specificity of bile CEA were 66.7% and 72.7% respectively while the sensitivity and speci- ficity of bile CA242 were 46.7% and 63.6% respectively. When both serum CA242 and bile CEA were determined combinatively, the sensitivity and specificity were 53.4% and 95.0% respectively. The subjects operating characteristic curve revealed that the areas under serum CEA and CA242 curves and bile CEA and CA242 curves were 0.570 （P 〉0.05）, 0.856 （P 〈0.01）, 0.759 （P 〈0.01）, and 0.491 （P 〉0.05） respectively. Conclusion The serum CA242 or the bile CEA alone has good sensitivity and specificity in the diagnosis of cholangiocarcinoma, and may be used as tumor markers in the diagnosis of cholangiocarcinoma. The serum CEA or the bile CA242 has no value in the diagnosis of cholangiocarcinoma. Combinative determination of both the serum CA242 and the bile CEA can markedly improve the specificity but decrease the sensitivity in the diagnosis of cholangiocarcinoma.