结直肠癌血清癌胚抗原、糖类抗原19-9表达水平及其临床价值探讨

Expression levels and clinical value of serum carcinoembryonic antigen,carbohydrate antigen 19- 9 in colorectal cancer

目的:探讨结直肠癌血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)表达水平以及在结直肠癌诊断、病情评估和预后判断中的作用。方法:本院自2010年6月至2011年6月共收治128例拟诊结直肠癌患者,采用电化学发光法检测患者CEA、CA19-9水平,并与结直肠镜及病理结果对比,判断CEA、CA19-9的诊断价值、与临床病理联系以及与预后的关系。结果:128例拟诊结直肠癌的患者中共确诊结直肠癌98例。CEA诊断的敏感性、特异性、阳性预测值、阴性预测值分别为67.3%、80.0%、90.3%、42.8%。CA19-9诊断的敏感性、特异性、阳性预测值、阴性预测值分别为69.3%、86.7%、93.5%、46.4%。联合检测的敏感性、特异性、阳性预测值、阴性预测值分别为89.8%、96.7%、98.9%、74.3%。联合诊断的敏感性、特异性、阴性预测值显著高于CEA、CA19-9单独检测(P<0.05)。TNM不同分期间CEA、CA19-9水平存在显著差异(P<0.05),低分化结直肠癌CEA、CA19-9水平显著高于高分化结直肠癌(P<0.05),管状腺癌的CEA、CA19-9水平显著高于黏液腺癌(P<0.05)。复发转移和死亡病例CEA、CA19-9水平显著高于生存病例(P<0.05)。结论:CEA、CA19-9联合诊断有助于提高诊断价值,CEA、CA19-9与临床病理分期、分化程度、病理类型关系密切,且有助于结直肠癌患者的预后判断。

Objective：To investigate expression levels and the role of the serum carcinoembryonic antigen （CEA）,carbohydrate antigen 19 - 9（CA19 - 9）in diagnosis,evaluation and prognosis of colorectal cancer. Meth-ods：All 128 patients diagnosed of colorectal cancer were treated and electrochemiluminescence was used for detection of CEA,CA19 - 9 level. Results：Of 128 cases,98 cases were finally diagnosed with colorectal cancer;Sensitivity,spe-cificity,positive predictive value,negative predictive value of CEA diagnostic were 67. 3% ,80. 0% ,90. 3% ,42. 8% . Diagnostic sensitivity,specificity,positive predictive value,negative predictive value of CA19 - 9 were 69. 3% , 86. 7% ,93. 5% ,46. 4% . Sensitivity,specificity,positive predictive value,negative predictive value of combined de-tection were 89. 8% ,96. 7% ,98. 9% ,74. 3% . Sensitivity,specificity,negative predictive value of combined detection were significantly higher than CEA,CA19 - 9（P 〈 0. 05）;There was significant difference between different TNM pe-riods in CEA,CA19 - 9 levels（P 〈 0. 05）;CEA,CA19 - 9 levels of poorly differentiated colorectal cancer were sig-nificantly higher than high differentiated colorectal cancer（P 〈 0. 05）;CEA,CA19 - 9 levels of tubular adenocarcino-ma were significantly higher than mucinous adenocarcinoma（P 〈 0. 05）;CEA,CA19 - 9 levels of recurrence and me-tastasis and deaths were significantly higher than the survival patients（P 〈 0. 05）. Conclusion：CEA,CA19 - 9 com-bined detection helps improve diagnostic value,and CEA,CA19 - 9 are closely related with clinical pathological stage,tumor differentiation,histological type.