血清肿瘤标记物联合动态检测在胃肠胰神经内分泌肿瘤诊断和治疗中的价值

The value of the serum tumor markers combined detection in the diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasm

目的探讨血清肿瘤标记物不同组合多项动态检测在胃肠胰神经内分泌肿瘤(GEP-NEN)早期诊断、临床分期、治疗动态观察和复发中的临床应用价值。方法对56例经手术和病理证实的GEP-NEN患者术前及术后1个月血清采用电化学发光法检测癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、神经元特异性烯醇化酶(NSE)、糖类抗原125(CA125)和环氧酶-1(COX-1)水平,用酶联免疫吸附试验法检测骨桥蛋白(OPN)及化学比色法检测恶性肿瘤特异性生长因子(TSGF)水平,并与30例良性肿瘤、30例黏膜炎性病变活检病例作对照,按照2010年WHO分类标准和中国GEP-NEN病理学诊断共识(2011年)分析CEA、CA19-9、NSE、CA125、COX-1、OPN、TSGF在GEP-NEN诊断、分级、临床分期和治疗监控的价值。对5例复发者比较血清肿瘤标记物与内镜活检病理检出时间差异。结果患者血清CEA、CA19-9、NSE、CA125、COX-1、OPN和TSGF水平神经内分泌癌组明显高于良性肿瘤对照组及正常黏膜组(P<0.01),手术治疗后其血清肿瘤标记物水平较术前明显下降(P<0.01),中晚期组、淋巴结转移组、复发组血清CEA、TSGF、OPN、CA19-9和NSE水平较早期组、无转移组、无复发组明显增高(P<0.05),与患者年龄、性别、肿瘤部位无关(P>0.05);四项组合CEA+TSGF+CA19-9+NSE联合检测敏感性高达96.43%,与单项检测敏感性比较差异有统计学意义(P<0.01),与七项组合比较敏感性无统计学差异(P>0.05)。结论 CEA、CA19-9、NSE、CA125、COX-1、OPN、TSGF均可作为GEP-NEN诊断、分级、临床分期和治疗监控的血清学检测指标;联合动态检测可显著提高诊断敏感性;以CEA+TSGF+CA19-9+NSE组合联合检测经济、敏感、准确,阴性预测值高,有利于早期诊断和治疗动态观察。

Objective To explore the clinical value of combined detection of CEA, CA19-9, NSE, CA125, COX-1, OPN arid TSGF in the diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasm（ GEP- NEN）. Methods The serum from 56 patients with GEP-NEN was collected and tumor markers CEA, CA19-9, NSE, CA125 and COX-1 was detected with electrochemiluminescence method, and OPN was detected with enzyme-linked immunosorbent assay method, and TSGF was detected with chemocolorimetry method, and was compared with 60 cases benign gastrointestinal disease. Results The serum levels of CEA,TSGF, OPN, CA19-9 and NSE in GEP-NEN patients were significantly higher than those in the benign gastrointestinal disease （ P 〈 0.01 ）, and had a positive correlation with the clinical stage（ P 〈0. 05 ）and lymphnode metastasis, and showed significantly higher in the group of recurence and metastasis than no recurrence and metastasis （P 〈 0.05 ）. The sensitivity of the CEA, TSGF, CA19-9 and NSE four tumor markes in combination was 96. 43% and specificity was 85.00%. Conclusion The dynamic combined detection of CEA,TSGF, CA19-9 and NSE four tumor markes are better prewarning markers for monitoring their recurrence and metastasis of gastrointestinal neuroendocrine neoplasm, and benefit to early diagnosis and interference. It was the indicator of early diagnosis of ovarian cancer and monitoring of treatment, recurrence, which has important value in clinical application.