腔内超声联合糖链抗原检测对肠道黏膜下肿瘤患者的随访价值

Significance of intracavity ultrasound combined with the sugar chain antigen in the diagnosis of intestinal submucosal tumors

目的探讨腔内超声联合糖链抗原CA19-9、CA125、CA72-4及CA242检测对肠道黏膜下肿瘤患者的随访价值。方法选取2013年1月至2016年2月间在四川省德阳市人民医院随访的174例肠道黏膜下肿瘤患者,分别于术前、术后2年内每隔3个月及术后2年后每隔半年时进行糖链抗原检查,采用电化学发光自动免疫分析法检测患者血清标志物,对于血清标志物阳性或显著上升患者及有消化道症状者,进行腔内超声检查,分析腔内超声结果和糖链抗原水平与患者治疗结果的关系。结果术后3个月,患者的C119-9、CA125和CA242水平低于术前,差异均有统计学意义(均P<0.05)。术后3个月时,C119-9、CA125、CA72-4和CA242阳性率分别为6.9%、3.4%、12.1%和6.9%低于术前的18.4%、15.5%、40.8%和20.1%,差异均有统计学意义(均P<0.05)。术后随访时间为(24.4±12.5)个月。其中,64例出现复发与转移,36例复发,其余均为转移。复发转移者复发转移时血清C119-9、CA125、CA72-4和CA242水平高于未复发转移时,差异均有统计学意义(P<0.05)。血清糖链抗原标志物出现一项阳性或显著上升者复发与转移前置时间为(2.84±0.52)个月,两项及以上阳性或显著上升诊断前置时间为(1.34±0.25)个月。随访期间,共检出糖链抗原标志物阳性或显著上升者79例,对复发或转移敏感性为82.8%(53/64),特异性为85.5%(94/110),符合率为84.5%(147/174)。超声内镜检查结果,新检出息肉3例,溃疡2例,均表现为血清标志物阳性,检出1例未见糖链抗原标志物上升但确诊为复发者。结论糖链抗原检测对肠道黏膜下肿瘤转移与复发诊断效率较高,联合腔内超声可提高诊断效率,减少假阳性和假阴性。

Objective To analyze the significance of intraeavity ultrasound combined with detection of CA19-9, CA125, CA72-4 and CA242 levels in patients with intestinal submueosal tumors during the fol- low up period. Methods Select 174 patients with intestinal submucosal tumors who were followed up by Deyang City People＇s Hospital from January 2013 to February 2016. Sugar chain antigen was tested at 2 years preoperatively and postoperatively, and every 3 months postoperatively and every 6 months at 2 years after surgery. Electrochemiluminescence immunoassay analyzer was used to detect serum markers. Ultra- sound was performed on patiehts with positive serum markers or intestinal symptoms. The relationship be- tween intracavity ultrasound and antigen levels and the outcomes of treatment was analyzed. Results At 3 months after surgery, levels of Cl19-9, CA125 and CA242 were significantly lower than preoperatively （P 〈0.05）. At 3 months after surgery,positive rate of Cl19-9, CA125, CA72-4 and CA242 was 6.9% , 3.4% , 12. lifo and 6. 9% , respectively which was lower than 18.4% , 15.5% , 40. 8% and 20. 1% , re-speetively of before surgery （P 〈0. 05）. Postoperative follow-up was （24. 4 ± 12. 5） months, during which recurrence and metastasis occurred in 64 patients with recurrence in 36 patiehts and metastasis in the rest of patiehts. For patients with recurrence and metastasis, serum C119-9, CA125, CA72-4 and CA242 levels were higher at recurrence than without recurrence （P 〈 O. 05 ）. For patients with one positive sugar chain antigen or significant increase in serum carbohydrate antigen markers, lead-time to recurrence and metasta- sis was （2. 84 ± 0. 52 ） months For patients with 2 or more positive sugar chain antigens or significant in- crease in serum carbohydrate antigen markers, lead-time to recurrence and metastasis was （ 1, 34 ± 0. 25 ） months. During the follow-up period, 79 patients were found with positive or significant increase in sugar chain antigens. The rate of sensibility, specificity and coincidence was 82. 8% （53/64）, 85.5% （94/ 110） and 84. 5% （147/174）. Ultrasound test revealed that 3 patients were newly detected with polyps and 2 patients with ulcer who had positive serum markers. One patient was diagnosed with recurrence but no sin- crease in sugar chain antigen was found. Conclusion The detection of sugar chain antigen can improve the diagnosis of metastasis and recurrence and when combined with intracavity ultrasound, it can help to im- prove the diagnostic efficiency and avoid the false positive and false negative diagnosis.