电化学发光法检测消化道肿瘤5项标志物的诊断试验与评价

Diagnostic test and evaluation of digestive tract tumor 5-index markers detected with electrochemiluminescence

目的探讨电化学发光法检测消化道肿瘤5项标志物[血清甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原72-4(CA72-4)和糖类抗原125(CA125)]的诊断特性与临床价值。方法检测185例消化道肿瘤患者和60例健康对照者血清消化道肿瘤5项标志物,在各组进行各种标志物检测值、阳性率及诊断参数比较。结果 AFP水平在原发性肝癌中最高,CA72-4水平在胃癌中最高,CA19-9和CA125水平在胰腺癌中最高,CEA水平在结直肠癌中最高。单项检测的敏感度、阴性预测值、Kappa值(K值)、诊断效率(DE)和诊断指数(DI)在原发性肝癌中以AFP最高,在胃癌以CA72-4最高,在胰腺癌和结直肠癌以CEA最高。特异度和阳性预测值在5项标志物的单项检测中均较高。联合检测明显提高了4种肿瘤诊断的敏感度(原发性肝癌、胃癌、胰腺癌和结直肠癌的敏感度分别为88.7%、78.0%、92.6%和87.3%),也明显提高了阴性预测值、K值、DE和DI,仅特异度和阳性预测值变化不大。结论消化道肿瘤标志物在不同肿瘤中的表达和诊断参数各不相同,多项肿瘤标志物联合检测能提高消化道肿瘤诊断的敏感度及其他诊断特性。

Objective To explore the diagnostic features and clinical values of the digestive tract tumors 5markers[alpha-fetoprotein（AFP）,carcinoembryonic antigen（CEA）,carbohydate antigen 19-9（CA19-9）,carbohydrate antigen 72-4（CA72-4）,carbohydrate antigen125（CA125）]detected with electrochemiluminescence.Methods The serum digestive tract tumors 5 markers were detected in 185 cases of digestive tract cancer and 60 healthy controls.The detected values,positive rates and diagnostic parameters of various markers were compared among various groups.Results The AFP level was highest in primary liver cancer.The CA72-4 level was highest in stomach cancer.The CA19-9 and CA125 levels were highest in pancreas cancer.The CEA level was highest in rectal cancer.In the sensitivity,negative predictive value,Kappa（K）value,diagnostic efficiency and diagnostic index（DI）of single indicator detection,the AFP level in primary liver cancer was highest,the CA72-4 level in gastric cancer was highest and the CEA level in pancreatic cancer and colorectal cancer was highest.Specificity and positive predictive value were higher in the single index detection of 5 markers.The combined detection obviously increased the sensitivity of 4 kinds of tumor（primary liver cancer,gastric cancer,pancreatic cancer and colorectal cancer）,and also increased the negative predictive value,K value,DE and DI,only specificity and positive predictive value had little change.Conclusion The expression and diagnostic parameters are different in different digestive tract tumors.The combined detection of multiple tumor markers can raise the sensitivity and other diagnostic features for diagnosing digestive tract cancers.