血清标志联合检测对胃肠胰神经内分泌肿瘤诊断价值分析

Combination of serum biomarkers for diagnosis of gastroenteropancreatic neuroendocrine neoplasm

目的:探讨癌胚抗原(carcinoembryonic antigen,CEA)、骨桥蛋白(osteopontin,OPN)、肿瘤抗原19-9(cancer antigens 199,CA19-9)和神经元特异性烯醇化酶(neural specificity enol,NSE)血清水平检测在胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasm,GEP-NEN)诊断和治疗中的应用。方法:检测56例GEP-NEN患者术前及术后1个月CEA、OPN、CA19-9和NSE血清水平,并与良性肿瘤组(30例)和健康对照组(30名)比较,分析其在GEPNEN诊断和疗效监测中的价值。结果:GEP-NEN组血清CEA、OPN、CA19-9和NSE水平分别为(39.22±21.21)ng/mL、(156.51±42.23)ng/mL、(58.13±13.42)U/mL和(37.21±12.78)ng/mL,明显高于良性肿瘤组的(2.71±2.01)ng/mL、(30.12±8.91)ng/mL、(13.12±6.23)U/mL和(10.47±4.87)ng/mL及健康对照组的(2.57±1.43)ng/mL、(28.89±7.92)ng/mL、(12.72±6.74)U/mL和(9.11±3.19)ng/mL,P值均<0.01;良性肿瘤组与健康对照组比较,差异无统计学意义,P>0.05。GEP-NEN患者术后1个月血清CEA、OPN、CA19-9和NSE水平分别为(21.34±11.34)ng/mL、(89.27±21.78)ng/mL、(38.27±7.23)U/mL和(22.41±7.28)ng/mL,明显低于术前(39.22±21.21)ng/mL、(156.51±42.23)ng/mL、(58.13±13.42)U/mL和(37.21±12.78)ng/mL,差异有统计学意义,P<0.01。NEN血清CEA、OPN、CA19-9和NSE水平与患者年龄、性别和肿瘤部位无关,P>0.05;与肿瘤组织学类型、分级、分期和淋巴结转移有关,P<0.05。CEA、CA19-9和NSE联合检测,可提高敏感性达96.43%,特异性85.00%,准确性90.52%,阴性预测值96.23%,再联合OPN可略提高敏感性,但降低特异性不能提高诊断的准确率。结论:血清CEA、OPN、CA19-9和NSE检测可作为GEP-NEN早期诊断和疗效监测指标,CEA+CA19-9+NSE联合检测敏感性、准确性和阴性预测值较高。

OBJECTIVE：To explore the clinical value of serum CEA,OPN,CA19-9 and NSE in gastrointestinal neu- roendocrine neoplasm. METHODS： The serum from 56 patients with gastrointestinal neuroendocrine neoplasm was col- lected and tumor markers CEA,CA19-9 and NSE was detected with electrochemiluminescence method, and OPN was de- tected with Enzyme-linked immunosorbent assay method,and was compared with 30 cases benign gastrointestinal disease and 30 health controls. RESULTS：The serum levels of CEA,OPN,CA19-9 and NSE in gastrointestinal neuroendocrine neoplasm patients were （39. 22 ± 21. 21） ng/mL, （156. 51± 42. 23） ng/mL, （58. 13± 13. 42） U/mL, and （37. 21 ±12.78） ng/mL,which were significantly higher than those in the benign gastrointestinal disease（2.71 ±2.01） ng/mL, （30.12±8. 91） ng/mL, （13. 12±6. 23） U/mL and （10. 47±4. 87） ng/mL and healthy control group（2. 57±1.43） ng/mL, （28.89±7.92） ng/mL, （12.72± 6.74） U/mL and （9.11±3.19） ng/mL （P〈0.01）. The serum levels of CEA,OPN, CA19-9 and NSE in gastrointestinal neuroendocrine neoplasm patients in postoperation were （21. 34± 11.34） ng/mL,（89.27±21.78） ng/mL,（38. 27±7. 23） U/mL and （22.41±7.28） ng/mL,which were lower than those in preoperation （39.22±21.21） ng/mL,（156.51±42.23） ng/mL, （58.13±13. 42） U/mL and （37.21±12.78） ng/mL （P%0.01）. The serum levels of CEA,OPN,CA19-9 and NSE in gastrointestinal neuroendocrine neoplasm patients had a positive correlation with the tumor histological types,grading,clinical stage and lymphnode metastas （P〈0.05） and had not related to patient age, sex, tumor site. The sensitivity of the CEA, CA19 9 and NSE three tumor markes in combination was 96.43 %, specificity was 85.00 ~, accuracy was 90.52 %, and negative predictive value was 96.23%. CONCLUSION： The dynamic combined detection of CEA, CA19-9 and NSE three tumor markes are better prewarning markers for monitoring their recurrence and metastasis of gastrointestinal neuroendocrine neoplasm, and benefit to early diagnosis and interference.