纯胰液肿瘤标志物对胰腺良恶性疾病的诊断价值

Determination of tumor markers in pure pancreatic juice for diagnosing pancreatic diseases

目的探讨纯胰液（ＰＰＪ）肿瘤标志物ＣＥＡ、ＣＡ５０和ＣＡ１９－９对胰腺良恶性疾病的诊断价值。方法对４５例胰管像有异常及３０例（２０例取ＰＰＪ）非胰腺疾病者经ＥＲＣＰ导管提取ＰＰＪ，用放免法测定ＰＰＪ和血清标志物。结果ＰＰＪ中ＣＥＡ界限值４５μｇ／Ｌ，ＣＡ５０和ＣＡ１９－９分别为３５ｋＵ／Ｌ和５０００ｋＵ／Ｌ。诊断胰腺癌ＰＰＪ中ＣＥＡ的敏感性与血清比较差异有显著意义（Ｐ＜０．０５），ＰＰＪ中ＣＥＡ、ＣＡ５０和ＣＡ１９－９的特异性和正确性与血清比较差异无显著意义（Ｐ＞０．０５）。非胰腺疾病ＰＰＪ中ＣＥＡ假阳性为０，ＣＡ５０和ＣＡ１９－９均为５％，慢性胰腺炎假阳性中，ＣＥＡ为１０％，ＣＡ５０为０和ＣＡ１９－９为２０％。两种以上ＰＰＪ标志物同时超过界限值为阳性时，其敏感性为４５．８％，特异性为１００％，正确性７５．９％。结论ＰＰＪ中ＣＥＡ、ＣＡ５０和ＣＡ１９－９三种标志物联合检测通过互补性对胰腺良恶性疾病有重要的诊断价值。

Objective Tumor markers, CEA, CA50, CA19 9 in pure pancreatic juice(PPJ) were determined in this study to clarify their diagnostic values for pancreatic disorders.Methods Through ERCP catheter a certain amount of PPJ was drawn from patients with pancreatic duct abnormality(n=45) and without pancreatic disorder(n=20).CEA, CA50 and CA19 9 in both serum and PPJ were tested with radioimmunoassay.Results The cutoff level of CEA, CA50 and CA19 9 in PPJ remained at 45μg/L, 35kU/L and 5000kU/L respectively.In patient with pancreatic cancer,the sensitivity of CEA in PPJ showed significance( P <0.05) when compared with that in serum,while the specificity and accuracy of CEA, CA50 and CA19 9 were insignificant( P >0.05).The false positive rate of CEA,CA50 and CA19 9 in PPJ from nonpancreatic subjects appeared 0%,5% and 5% correspondingly,the false positivity of those in PPJ from those with chronic pancreatitis were 10%,0% and 20% accordingly.Taking two of the three tumor markers above cutoff level at same time as positivity standard,the sensitivity and specificity of the markers in diagnosing pancreatic cancer rose to 45.8% and 100% respectively.Conclusion Simultaneous assay of the three markers plays an essential and compensatory role,beneficial to differentiate pancreatic malignancy from the benign.