血清CA153、CA125、CEA联合检测在乳腺癌诊断中的价值

Clinical value of serum CA153,CA125,CEA combined detection in the diagnosis of breast cancer

目的:探讨血清糖类抗原(Carbohydrate antigen,CA)153、CA125、癌胚抗原(Carcinoembryonic antigen,CEA)联合检测在乳腺癌诊断中的临床价值。方法:采用化学发光微粒子免疫分析技术(Chemiluminescent microparticle immunoassay,CMIA)测定81例乳腺癌患者、55例乳腺良性疾病患者和67例健康女性血清中CA153、CA125、CEA的含量。结果:乳腺癌组的CA153、CA125、CEA水平和阳性率均显著高于乳腺良性疾病组和健康对照组(均P<0.05);3项肿瘤标志物中,CA153阳性率最高(49.38%);CA153、CA125、CEA联合检测的敏感性为69.14%,特异性为96.72%,准确度为85.71%,阴性预测值为82.52%,除特异性略有下降,其余指标均高于单项检测。Ⅰ、Ⅱ期乳腺癌患者CA153单项检测的阳性率(15.91%)明显低于Ⅲ、Ⅳ期患者(89.19%),CA153、CA125、CEA联合检测显著提高了各期乳腺癌患者诊断的阳性率(Ⅰ、Ⅱ期:47.73%,Ⅲ、Ⅳ期:94.59%)。CA153、CA125、CEA的受试者工作特征(Receiver operating characteristic,ROC)曲线下面积分别为0.774、0.664、0.690,联合检测的ROC曲线下面积为0.807。结论:单项肿瘤标志物检测在乳腺癌的早期诊断中应用价值不高。CA153、CA125和CEA联合检测有助于提高乳腺癌的诊断性能和早期检出率,有助于乳腺癌和乳腺良性病变的鉴别诊断,3项联合检测是检查乳腺癌较为理想的标志物组合。

Objective： To evaluate the clinical value of serum carbohydrate antigen （CA） 153, CA 125, carcinoembryonic antigen （CEA） combined detection in the diagnosis of breast cancer. Methods：Chemiluminescent microparticle immunoassay （CMIA） was used to detect the serum levels of CA153,CA125,CEA in 81 patients with breast cancer,55 patients with benign breast diseases and 67 healthy women. Results：The levels and positive rates of CA153, CA125 and CEA in patients with breast cancer were significantly higher than those in patients with benign breast diseases and healthy controls（P〈0.05）. The positive rate of CA153（49.38%） was the highest among three tumor markers. The sensitivity, specificity, accuracy and negative predictive values of combined detection of CA153, CA125 and CEA were 69.14%,96.72%,85.71% and 82.52%,respectively. The value of specificity in combined detection was decreased slightly, while the values of other indicators were higher in combined detection than in single detection. The positive rate of CA153 was obviously lower in breast cancer patients at stage I and H （15.91%） than in those at stage m and 1V（89.19%）. The combined detection of CA153,CA125 and CEA greatly improved the positive rates for breast cancer patients at different clinical stages （stage I and ]/： 47.73%, stage m and IV ： 94.59% ）. The area under receiver operating characteristic （ROC） curves of CA 153, CA125 and C EA was 0.774,0.664 and 0.690 respectively. The area under ROC curves of the combined detection was 0.807. Conclusions ：The clinical value of single tumor marker detection in the early diagnosis of breast cancer is limited. The combined detec- tion of CA 153, CA125 and CEA is beneficial to improving the diagnosis performance as well as to increasing the early diagnosis rate for breast cancer. In addition, it is helpful to the differential diagnosis between breast cancer and benign breast diseases. The combined detection of CA 153, CA 125 and CEA is an ideal marker combination in the detection of breast cancer.