消化系统肿瘤标记物联合检测的临床意义

Clinical significance of combined Tests with malignant tumor in digestive system

目的探讨联合检测甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原19-9（CA19—9）辅助诊断消化系统恶性肿瘤的临床应用价值。方法对821例消化系统恶性肿瘤患者采用化学发光法检测血清AFP、CEA、CA19-9水平。结果恶性肿瘤组和良性肿瘤组AFP、CEA、CA19—9水平均明显高于健康对照组（t=2．345、2．224，均P〈0．05；t=2．785、2．749、2．897、2．865，均P〈0．01）；恶性肿瘤组AFP、CEA、CAl9-9水平均明显高于良性肿瘤组（t=2．445，P〈0．05；t=2．745、2．819，均P〈0．01）；肝癌患者AFP水平明显高于其它癌症（t=2．715、2．812、2．877、2．845、2．799，均P〈0．01）；肝癌患者CEA水平明显低于结、直肠癌和胰腺癌（t=2，775、2．801，均P〈0．01）；胰腺癌、胆道恶性肿瘤CA19—9水平明显高于其它癌症（t=2．733、2．851、2．788，均P〈0．01）；肝癌、胃癌、结直肠癌、胰腺癌、胆道恶性肿瘤3项联合检测阳性率分别为91．0％、90．0％、88．0％、90．0％、70．2％均高于单项检查阳性率85．0％、72．0％、67．5％、79．4％、55．3％（x^2=3．781、3．841、3．798、3．814、3．994，均P〈0．05）。结论三项肿瘤标记物均可作为消化系统恶性肿瘤的辅助诊断指标，联合检测可提高消化系统恶性肿瘤的检出率。

Objective To investigate the clinical value of combined tests ,including A-fetus protein （AFP）, cancer embryo agent （CEA） , earbonhydrate agent 19-9 （CA19-9）for the diagnosis of malignant tumors in digestive system. Methods ChemicaliU-umination tests were used to detect serum levels of AFP,CEA and CA 19-9 in 821 pa- tients with diseases of digestive system. Results The levels of AFP, CEA, CA19-9 in malignant group and the benign group were significandy higher than the control group （ t = 2. 345,2. 224, all P 〈 0.05 ; t = 2. 785,2. 749,2. 897, 2. 865, all P 〈0.01） ;The levels of AFP,CEA,CA19-9 in malignant group were signifieandy higher than benign group （ t = 2. 445, P 〈 0.05 ; t = 2. 745,2.819, all P 〈 0.01 ） ; The level of AFP in liver cancer group was significantly higher than other groups （ t = 2.715,2.812,2. 877,2. 845,2. 799, all P 〈 0.01 ） ; The level of CEA in liver cancer group was significantly lower in patients with liver colorectal cancer and pancreatic cancer （ t = 2. 775,2.801, all P 〈 0.01 ） ; The level of CA19-9 in bile duct cancer group was significantly higher than that of other cancers （ t = 2. 733,2.851,2. 788, all P 〈 0.01 ） ; The positive rates of liver,stomach ,colorectal cancer,pancreatic cancer,bile duct cancer combined detection in three item were 91.0% ,90.0,88.0% ,90.0% ,70.2% which were higher than the single check-positive rate of 85.0% ,72.0% ,67.5 % ,79.4% ,55.3 % （ X2 = 3.781,3.841,3. 798,3.814,3. 994, all P 〉 0.05）. Conelttsion The three tumor markers could be used as attxiliary diagnostic and joint detection which could improve the detection rate in patients with malignant tumors of digestive system.