肿瘤标志物联合检测对消化系统肿瘤的诊断价值

Clinical Value of Combined Detection of Tumor Markers in Diagnosis of Digestive System Neoplasm

探讨甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原125(CA-125)联合检测对消化系统恶性肿瘤的筛查作用及其适用人群。比较我院行AFP、CEA、CA19-9、CA-125检测的恶性肿瘤患者和良性消化系疾病患者的四项肿瘤标志物的含量,计算并比较其灵敏度、特异性、准确性、阳性预测值及阴性预测值。结果发现,联合检测CA-125+CA19-9能明显提高消化道空腔器官的恶性肿瘤诊断的灵敏度,但特异性及阳性预测值下降。联合检测更多的肿瘤标志物并不能使诊断准确性提高。对于消化系统实质器官的恶性肿瘤来说,联合检测肿瘤标志物无实际应用价值。去除肝硬化患者、良性胆道疾病及病毒性肝炎患者可明显提高特异性及灵敏度,联合检测CA-125+CA19-9对于合适的患者有助于提高消化系统空腔器官恶性肿瘤的早期检出率。

To explore the sensitivity and specificity of combined detection of serum AFP, CEA, CA19-9 and CA-125 in malignant tumors of the digestive system, and to explore appropriate population for combined detection of the four tumor markers. Patients suspected of suffering from malignant tumors of the digestive system and had their blood tested for the four tumor markers were included in this study. The sensitivity, specificity, accu- racy, positive predictive values and negative predictive values were compared for testing their diagnostic efficacy. The results showed that patients with cavitary organs of the digestive system combined testing of CA-125 and CA19-9 improved sensitivity, but lowered specificity and accuracy for detecting malignant tumors of the diges- tive system. And the positive predictive value was low. Combined testing of more tumor markers did not improve diagnostic efficacy. For solid organs of the digestive system, combined testing of tumor markers did not improve diagnostic efficacy. When patients with benign diseases of the biliary tract, patients with liver cirrhosis or viral hepatitis were excluded, specificity, accuracy and positive predictive value were significantly improved. Combined detection of CA-125 and CA19-9 contributes to improved early detection rate of malignant tumors of only cavitary organs of the digestive system, under condition of appropriate patient selection.