胃癌患者CEA、CA19-9、CA72-4及幽门螺旋杆菌抗体测定及其临床意义

ANALYSIS OF CEA, CA19 9, CA72 4 AND HELICOBACTER PYLORI ANTIBODIES IN PATIENTS WITH GASTRIC CANCER

对１６２例经手术和病理证实的胃癌患者血中的肿瘤标记物ＣＥＡ、ＣＡ１９９、ＣＡ７２４及幽门螺旋杆菌（ＨＰ）抗体进行了测定，并以９０例非肿瘤患者作为对照。结果：胃癌组患者ＣＥＡ、ＣＡ１９９及ＣＡ７２４的敏感性分别为２４．０％、３５．５％和２１．９％，特异性分别为９３％、７７％和１００％；阳性预测值（拟然比）分别为８５．７％（３．２４）、７８．６％（１．５２）和１００％（０），阴性预测值（拟然比）分别为３９．９％（０．２８）、３３．０％（０．８４）和３８．９％（０．７８）。ＣＡ１９９及ＣＡ７２４的含量随肿瘤直径的增大而明显增高（Ｐ＜０．０５）；当肿瘤浸润深度增加时，ＣＡ１９９含量也显著增高（Ｐ＜０．０５）。在淋巴结转移率＞５０％或有远处转移的患者，其ＣＥＡ、ＣＡ７２４及ＣＡ１９９含量显著增加；在肿瘤分化差的患者，这３种肿瘤标记物的含量均明显高于对照组（Ｐ＜０．０５）。胃癌患者ＨＰ抗体阳性率为５４％，对照组为２２％（χ２＝２３．３１９，Ｐ＜０．００１；比数比为３．７５，９５％可信限为２．１１～５．４１，Ｐ＜０．０１）。结论：ＣＥＡ、ＣＡ１９９及ＣＡ７２４在胃癌的诊断性试验中特异性高而敏感性低；?

Serum tumor markers CEA, CA19 9, CA72 4 and Helicobacter pylori (H.pylori) antibodies were measured in 162 patients with gastric cancer. CEA, CA19 9 and CA72 4 had sensitivities of 24.0%, 35.5% and 21.9% respectively. CA72 4 provided 100% specifity, compared to 77% and 93% for CA19 9 and CEA. The positive predictive value (PV) in CEA, CA19 9 and CA72 4 was higher than negative PV. Serum CA19 9 and CA72 4 levels rose in tumor of >5.0cm in diameter. The CA19 9 increased remarkably when the deeper stomach wall was invased. The significantly elevated CEA, CA72 4 and CA19 9 levels were found in patients who had nodal involvement in more than 50% and distant metastasis. However, the increase of CEA, CA19 9 and CA72 4 were found in undifferentiated tumor. Antibodies to H.pylori were detected in 54% of patients but in only 22% control subjects. A significant association was found between H.pylori infection and gastric cancer (odds ratio=3.75; 95% confidence interval=2.11-5.41, P < 0.01). Conclusions: CEA, CA19 9 and CA72 4 have higher specifity but lower sensitivity in diagnosis of the gastric cancer. The levels of CEA, CA19 9 and CA72 4 are significantly associated with the diameter, the depth of invasion, nodal involvement, distant metastasis and cell differention. Infection with H.pylori may be an important cause of gastric cancer.