联合检测肿瘤标志物在卵巢肿瘤筛查中的意义

Value of combined multiple tumor markers in the diagnosis of ovarian tumors

目的 探讨多项肿瘤标志物联合检测对卵巢肿瘤性质的诊断意义.方法 经病理确诊的卵巢肿瘤患者83例,采用磁化学发光法检测其多项肿瘤标志物：糖链多肽抗原（CA）125、CA19-9、甲胎蛋白（AFP）、癌胚抗原（CEA）、血清铁蛋白（FT）,分析其结果与临床诊断的关系.结果 恶性卵巢肿瘤中任何一项肿瘤标志物的阳性率为83.87%（26/31）,而良性卵巢肿瘤为36.54%（19/52）,两者比较差异有统计学意义（P＜0.05）.各项肿瘤标志物在恶性卵巢肿瘤、卵巢子宫内膜异位囊肿、良性卵巢肿瘤中的阳性率比较,差异均有统计学意义（P＜0.05）,且在恶性卵巢肿瘤中的阳性率最高.CA125诊断恶性卵巢肿瘤灵敏度最高（74.2%）,但特异度（55.8%）和阳性预测值（50.0%）低;CEA、AFP和Fr的特异度（均为98.1%）虽高,但灵敏度（分别为16.1%、3.2%、16.1%）低;CA125与其他肿瘤标志物联合检测可以提高其特异度和阳性预测值.结论 多项肿瘤标志物联合检测可以显著提高卵巢恶性肿瘤诊断的准确性,为处于亚临床期的卵巢癌患者和正常体检人群中卵巢肿瘤的筛查提供了可靠的检测方法.

Objective To appraise the value of combined multiple tumor markers in the diagnosis of ovarian tumors. Methods Eighty-three patients with ovarian tumors confirmed by pathological diagnosis were tested with combined multiple tumor markers including CA125,CA19-9,alpha-fetoprotein （AFP）,carcinoembryonic antigen （CEA）, serum ferritin （FT） preoperatively by automated chemiluminescence assay,and the relations between the results and the pathological diagnosis were analyzed retrospectively.Results There was statistical difference among the positive rates of tumor markers in malignant [ 83.87%（26/31 ） ] and benign ovarian tumors [ 36.54% （19/52） ] （P 〈 0.05 ）. Every tumor marker had its sensitivity and specificity,but CA125 was the best marker of all. Its sensitivity was 74.2%, specificity was 55.8%,positive predictive value was 50.0% ,the specificity of CEA,AFP and FT was all 98.1%, the sensitivity of those was 16.1%, 3.2%, 16.1% respectively. When combined with the others,it could improve its specificity and positive predictive value,but the sensitivity declined greatly. Conclusion The accuracy of distinguishing the malignant from benign ovarian tumors is enhanced by combined multiple tumor markers testing.