多种肿瘤标志物在胰腺癌中的诊断价值及相关性研究

Diagnostic value and correlation of multiple tumor markers in pancreatic cancer

目的:探讨血清肿瘤标志物联合检测对胰腺癌的诊断价值及相关性。方法:选取2013年1月至2016年5月我院胰腺癌患者146例,非胰腺癌患者128例和健康体检者124例,放射免疫分析仪检测各组血清CA19-9、CA242、CA50、CA125、CEA及TSGF水平,并进行各组间比较。绘制受试工作特征曲线(ROC)分析各肿瘤标志物在胰腺癌患者中的诊断价值,线性相关分析各肿瘤标志物的相关性。应用多元Logistic回归模型分析胰腺癌的独立危险因素。结果:胰腺癌组血清CA19-9、CA242、CA50、CA125、CEA及TSGF水平明显高于对照组和非胰腺癌组,差异有统计学意义(P<0.05或P<0.01)。Ⅳ期和Ⅲ期患者血清CA19-9、CA242、CA50、CA125及TSGF水平明显高于Ⅰ期和Ⅱ期(P<0.01),且Ⅳ期患者血清CA19-9、CA242、CA125及CEA水平明显高于Ⅲ期(P<0.01)。胰腺癌组血清CA19-9、CA242、CA50、CA125、CEA及TSGF的阳性率明显高于对照组和非胰腺癌组(P<0.01)。ROC曲线显示,血清CA19-9的AUC高于其他单项指标,其最佳临界值、灵敏度和特异度分别为114.5 U/ml、81.2%和79.3%。6项联合检测的诊断效能均优于各单项检测,其灵敏度和特异度分别为92.4%和76.5%。相关性分析显示,血清CA19-9与CA242、CA50及CA125均呈正相关(r=0.703,P=0.005;r=0.572,P=0.024;r=0.439,P=0.036)。多元Logistic回归分析显示,吸烟、不正确的饮食习惯、糖尿病史、胆系疾病史及CA19-9、CA242、CEA进入回归模型,其OR值及95%CI分别为1.717(0.736~2.359)、2.865(2.217~3.685)、2.614(2.186~3.127)、3.527(2.842~4.377)、4.214(3.570~4.962)、2.315(2.114~2.539)、1.876(1.175~2.852)。结论:血清肿瘤标志物联合检测有助于提高早期胰腺癌诊断的准确性,吸烟、不正确的饮食习惯、糖尿病史、胆系疾病史及高水平的CA19-9、CA242、CEA是胰腺癌的独立危险因素。

Objective： To explore the diagnostic value and correlation of serum tumor markers combined detection of pancreatic cancer. Methods： Selected January 2013 to may 2016 in our hospital in patients with pancreatic cancer in 146 cases,128 cases of non pancreatic cancer with patients and 124 cases of healthy physical examination. Radiation immunity analyzer test groups of serum CA19-9,CA242,CA50,CA125,CEA and TSGF levels and compared between groups. To draw the working characteristic curve（ ROC） to analyze the diagnostic value of tumor markers in patients with pancreatic cancer and the correlation of linear correlation analysis of tumor markers. Analysis of independent risk factors for pancreatic cancer using multiple logistic regression models. Results： The pancreatic cancer group of serum CA19-9,CA242,CA50,CA125,CEA and TSGF levels were significantly higher than the control group and non pancreatic cancer group,the differences were statistically significant（ P〈0. 05 or P〈0. 01）. Ⅳ stage and Ⅲ stage with patients of serum CA19-9,CA242,CA50,CA125 and TSGF levels were significantly higher than Ⅰ stage and Ⅱ stage with patients（ P〈0. 01）. Ⅳstage with patients of serum CA19-9,CA242,CA125 and CEA levels were significantly higher than Ⅲ stage with patients（ P〈0. 01）.The pancreatic cancer group of serum CA19-9,CA242,CA50,CA125,CEA and TSGF of positive rate were significantly higher than that of control group and non pancreatic cancer group（ P〈0. 01）. ROC curves showed that the AUC of serum CA19-9 were higher than other single indexes,the best critical value,sensitivity and specificity were 114. 5 U / ml,81. 2% and 79. 3% respectively. The diagnostic efficacy of the six joint detection were better than the single detection,the sensitivity and specificity were 92. 4% and 76. 5% respectively. Correlation analysis showed that serum CA19-9 were positively correlated with CA242,CA50 and CA125（ r = 0. 703,P = 0. 005; r =0. 572,P = 0. 024; r = 0. 439,P = 0. 036）. Multiple logistic regression analysis showed that smoking,incorrect diet,history of diabetes,gallbladder disease history and high levels of CA19-9,CA242,CEA into the regression model,the OR value and 95% CI were 1. 717（ 0. 736 to 2. 359）,2. 865（ 2. 217 to 3. 685）,2. 614（ 2. 186 to 3. 127）,3. 527（ 2. 842 to 4. 377）,4. 214（ 3. 570 to 4. 962）,2. 315（ 2. 114 to 2. 539）,1. 876（ 1. 175 to 2. 852）. Conclusion： Serum tumor markers combined detection can help to improve the accuracy of early diagnosis of pancreatic cancer and smoking,incorrect diet habits,history of diabetes,biliary disease history and high levels of CA19-9,CA242 and CEA are independent risk factors for pancreatic cancer.