血清肿瘤标志物在直肠癌诊断中的应用

Clinical application of tumor marks with rectal cancer

目的探讨血清中肿瘤标记物在直肠癌诊断中的临床应用价值。方法选取136例直肠癌患者(直肠癌组),根据临床分期,将直肠癌分为Ⅰ期组、Ⅱ期组、Ⅲ期组、Ⅳ期组,另选取肠道良性病变者65例作为对照组,对各组3种血清肿瘤标志物:血清糖蛋白抗原19-9(CA19-9)、癌胚抗原(CEA)、糖蛋白抗原72-4(CA72-4)水平及相关值进行比较。结果直肠癌组CA19-9、CEA、CA72-4浓度分别为(49.87±16.33)IU/mL、(14.37±15.12)μg/L、(21.27+18.11)IU/mL,且均明显高于对照组(P<0.05)。3种血清肿瘤标记物CA19-9、CEA、CA72-4中,CA72-4的敏感度(SEN)最高(55.1%),CEA的特异度(SPE)最高(78.5%),CA72-4的约登指数(YI)最高(24.3%),CEA的阳性预测值(+PV)最高(79.7%)。经平行试验后,CA19-9+CEA+CA72-4的SEN升高到80.9%,序列试验后,CA19-9+CEA+CA72-4的SPE升高到93.8%。Ⅲ期组、Ⅳ期组血清CA19-9、CEA、CA72-4浓度均明显高于Ⅰ期组、Ⅱ期组浓度,其浓度的高低与直肠癌的临床分期存在相关性。结论 CA19-9、CEA、CA72-4可用于辅助诊断直肠癌及预测临床分期。

Objective To explore the clinical application of tumor marks with Rectal Cancer .Methods 136 patients with rectal cancer were divided into Ⅰ stage group ,Ⅱ stage group ,Ⅲ stage group ,Ⅳ stage group according to clinical stage ,65 people of intestinal benign lesions as control group .For each group three kinds of serum tumor markers ：carbohydrate antigen 19-9 （CA19-9） ,carcino embryonic antigen （CEA ） and carbohydrate antigen 72-4 （CA72-4） levels and associated values .Results The levels of CA19-9 , CEA and CA72-4 in rectal cancer group were （49 .87 ± 16 .33） IU/mL ,（14 .37 ± 15 .12）μg/L and （21 .27 ± 18 .11） IU/mL ,SEN is highest in CA72-4 ,at 55 .1% ;the highest SPE is CEA ,CA72-4 has highest YI , T HE＋ PV is highest in CEA .In parallel detection , the SEN of CA19-9 ＋ CEA ＋ CA72-4 went up to 80 .9% and in sequence detection ,the SPE of CA19-9＋CEA＋CA72-4 went up to 93 .8% .The concentra-tion of CA19-9 ,CEA ,CA72-4 in Ⅲ stage and Ⅳ stage were higher than these in Ⅰ stage and Ⅱ stage ,so the clinic stage was related to the concentration of tumor marks .Conclusion CA19-9 ,CEA ,CA72-4 may-be could assist to diagnose rectal cancer and predict clinic stage .