CA19-9、CA242及CEA联合检测在良恶性梗阻性黄疸鉴别诊断中的应用

Combination detection of carbohydrate antigen 19-9,carbohydrate antigen 242 and carcinoembryonic antigen in differential diagnosis of benign and malignant obstructive jaundice

目的:评价血清肿瘤标志物糖链抗原19-9(CA19-9)、糖链抗原242(CA242)及癌胚抗原(CEA)联合检测鉴别诊断良恶性梗阻性黄疸的临床价值。方法:采用免疫放射分析法对88例恶性梗阻性黄疸患者和52例良性梗阻性黄疸患者的血清CA19-9、CA242和CEA进行检测,绘制ROC曲线并计算曲线下面积(AUC),对CA19-9、CA242和CEA单独及联合检测的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比进行分析。结果:CA19-9、CA242和CEA在恶性梗阻性黄疸组的水平均显著高于良性梗阻性黄疸组(P<0.01),CA19-9、CA242和CEA、AUC分别为0.882、0.904和0.843,阳性似然比依次为1.96、6.04和10.44,阴性似然比依次为0.11、0.30和0.42。系列联合检测(三项检查)阳性,其特异性较单项检查明显增高;而平行联合检测(三项检查中有一项为阳性)阳性,则灵敏度较单项检查明显增高。结论:CA19-9、CA242及CEA联合检测对鉴别良恶性梗阻性黄疸有一定的临床意义。

Objective：To evaluate the clinical significance of serum tumor markers carbohydrate antigen 19-9（CA19-9）,carbohydrate antigen 242（CA242）and carcinoembryonic antigen（CEA）in differential diagnosis of benign and malignant obstructive jaundice.Methods：Serum levels of CA199,CA242 and CEA were detected by radioimmunoassay in 88 patients with malignant obstructive jaundice and 52 patients with benign obstructive jaundice.The receiver-operating characteristics curve（ROC） of the three serum tumor markers was made and the areas under the curve（AUC） were calculated.The sensitivity,specificity,positive predict value,negative predict value,positive likelihood ratio and negative likelihood ratio of CA199,CA242 and CEA were calculated and analyzed.Results：CA19-9,CA242 and CEA in patients with malignant obstructive jaundice were significantly higher than those in patients with benign obstructive jaundice（P0.01）.The AUC of CA19-9,CA242 and CEA were 0.882,0.904 and 0.843,respectively.The positive likelihood ratio priority of CA19-9,CA242 and CEA were 1.96,6.04 and 10.44,respectively,and the negative likelihood ratio priority was 0.11,0.30 and 0.42,respectively.Serial combination testing increased the diagnostic specificity,and parallel combination testing increased the diagnostic sensitivity.Conclusions：Combined measurement of serum CA19-9,CA242 and CEA is valuable in differential diagnosis of benign and malignant obstructive jaundice.