超声内镜联合肿瘤标记物对胰腺癌早期筛查的研究

Early screening of pancreatic cancer by combination of EUS with tumor marker detection

目的研究超声内镜联合检测血清糖链抗原CA19-9、CA242水平对胰腺癌早期诊断的临床应用价值。方法采用超声内镜探查102例高危人群胰腺的整体情况，同时采用酶链免疫吸附实验法检测血清CA19—9和CA242水平。结果9．80％（10／102）的病人血清CA19—9异常，12．75％（13／102）的病人CA242异常，二者均异常者7例，其中3例行EUS检查明确胰腺癌诊断，1例临床诊断胰腺癌，1例腹膜后占位，2例正常。102例人选者同时行超声内镜检查，2例显示胰头部不规则低回声区，2例显示胰腺囊实性肿物，3例诊断为胰腺癌，并得到手术病理证实。血清CA19—9诊断正确百分率为90．20％（92／102），灵敏度为50％（4／8），特异度为93．62％（88／94）；血清CA242诊断正确百分率为87．25％（89／102），灵敏度为50％（4／8），特异度为90．43％（8S／94）；EUS联合CA19—9、CA242诊断胰腺癌正确百分率为98．04％（100／102），灵敏度为100％（8／8），特异度为97．87％（92／94）。EUS联合CA19—9、CA242诊断胰腺癌的正确百分率显著高于CA242（P〈0．01），明显高于CA19-9诊断的正确百分率（P〈0．05）。结论超声内镜联合检测血清糖链抗原CA19-9、CA242对胰腺癌早期筛查具有较高的价值。

Objective To determine the clinical value of EUS in combination with detection of CA19-9 and CA242 for early diagnosis of pancreatic cancer. Methods General features of high-risk group were determed by EUS and the plasma levels of CA19-9 and CA242 measured by ELISA. Results The serum level of CA19-9 was abnormal in 9.80% （10/102） and that of CA242 in 12.75% （13/102） of the patients. They were both abnormal in 7 cases. Of the 7 cases, 3 were found to suffer from pancreatic cancer by EUS, 1 had the tumor that had been clinically confirmed, 1 had posterior peritoneal tumor and 2 were normal. Among 102 cases detected by EUS, 2 showed low echo in pancreatic head, 2 semi cyst, 3 pancreatic cancer and proved by pathology. Accurate diagnotie rate, sensitivity and specificity were 90.20%（92/102）, 50%（4/8） and 93.62%（88/94）, respectively, for serum CA19-9. For the serumCA242, the 3 parameters were 87.25%（89/102）, 50%（4/8） and 90.43% （85/94）, respectively. For combination of both methods, they were 98.04%（100/102）, 100%（8/8） and 97.87 % （92/94）, respectively. Accurate diagnostic rate of the latter was significantly higher than that of the former 2（P〈0. 05）. Conclusion Combination of EUS with detection of serum CA19-9 and CA242 is of great vlaue for early screening of pancreatic cancer.