乳腺导管内乳头状病变糖类抗原153、癌胚抗原及糖类抗原125联合检测的临床价值

The clinical significance of CA153, CEA and CA125 in nipple discharge of breast intraductal papillary leision

目的 探讨乳头溢液糖类抗原153（CA153）、癌胚抗原（CEA）及糖类抗原125（CA125）联合检测在乳腺导管内乳头状病变诊断中的价值.方法 检测154例乳腺导管内乳头状病变患者（恶性组58例,良性组96例）乳头溢液中CA153、CEA及CA125的水平,分析其诊断价值及其与临床病理因素的关系,另选30例妊娠健康妇女乳头溢液作对照.结果 恶性组乳头溢液中CA153、CEA及CA125水平[（130.11±29.62）U/ml、（89.23±28.94） ng/ml、（41.29±16,61）U/ml]显著高于良性组和健康组（P＜0.01）;与良性组和健康组比较,恶性组溢液中CA153、CEA、CA125单项检测阳性率（62.07％、46.55％、55.17％）及联合检测阳性率（82.76％）均明显增高（P＜0.05）;恶性组乳头溢液联合检测阳性率显著高于单项检查（P＜0.01）.乳头溢液及血清三项联合检测可提高敏感性（96.55％）和阴性预测值（97.30％）.溢液CA153、CEA、CA125水平在患者年龄、部位、肿瘤大小、溢液性状不同组间差异无统计学意义（P＞0.05）;溢液CA153、CEA水平在雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体-2（Her-2）、缺氧诱导因子-1α（HIF-1 α）及淋巴结转移不同组差异有统计学意义（P＜0.05）;CA125在HIF-1 α、Ki-67不同组间差异有统计学意义（P＜ 0.05）;CA125在ER＆ PR、Her-2不同组间,CA153水平在Ki-67不同组间差异无统计学意义（P＞0.05）.结论 乳头溢液及血清CA153、CEA及CA125联合检测有互补性,能弥补单项检测临床应用的不足,对提高乳腺导管内乳头状癌诊断的敏感性和阴性预测值有一定意义.

Objective To study the value of tumor markers of CA153,CEA and CA125 in nipple discharge of breast intraductal papillary leision on detection of breast carcinoma.Methods 154 cases of breast intraductal papillary leision with nipple discharge were studied.Among them there were 58 cases with breast intraductal papillary carcinoma and 96 cases with intraductal papilloma.The nipple discharged and serum from the 154 cases were collected and CA153,CEA and CA125 levels were measured both in nipple discharge and serum with electrochemiluminescence method,and were compared with the results of ER,PR,HIF-1α and Ki-67 detected by SP method in breast tissue.Results The CA153,CEA and CA125 levels of nipple discharge in intraductal papillary carcinoma [（130.1 1±29.62） U/ml,（89.23±28.94） ng/ml,（41.29±16.61） U/ml]were significantly higher than those of the contrast groups,and had a positive correlation with the Ki-67,HIF-1αand lymphnode metastas （P ＜ 0.05）,and negative correlation with the level of ER,PR and Her-2 （P ＜ 0.05）.The positive rate of CA153,CEA or CA125 in nipple discharge （62.07 ％,46.55 ％,55.17 ％） were significantly higher than that in serum （P ＜ 0.05）.The sensitivity of the combined detection of the three tumor markes both in discharge and serum was 96.55 ％,and the negative predictive value was 97.30 ％,which were significantly higher than that in other detection （P ＜ 0.05）.Conclusions The positive rate of CA153,CEA and CA125 in nipple discharge were significantly higher than that in serum.The dynamic combined detection of CA153,CEA and CA125 both in nipple discharge and in serum could increase the diagnosis rate of breast intraductal papillary carcinoma.