血清CA199和CEA联合检测对结直肠癌早期诊断的临床意义

Clinical significance of serum CA199 and CEA combination detection in early diagnosis of colorectal cancer

目的探讨血清糖类抗原199（CA199）和癌胚抗原（CEA）联合检测对结直肠癌早期诊断的临床意义。方法收集76例结直肠癌患者的临床资料，采用化学发光法检测血清中CEA、CA199水平，比较单项CEA、CA199及双指标联合检测对结直肠癌的诊断敏感性、特异性及检出率；比较结直肠癌不同分期患者血清CEA、CA199检测水平；比较上皮内瘤变、原位癌、浸润癌患者血清CEA、CA199检测水平。结果双指标联合检测敏感性及检出率高于单项CEA、CA199检测，差异有统计学意义（P〈0.05）。单用CEA与单用CA199检测在特异性、敏感性方面比较差异均未见统计学意义（P均〉0.05）；单用CEA检测检出率高于单用CA199检测，差异有统计学意义（P〈0.05）。Ⅰ、Ⅱ、Ⅲ、Ⅳ期结直肠癌患者CEA水平比较差异未见统计学意义（P〉0.05），CA199水平比较差异有统计学意义（P〈0.05）；CA199检测值与分期呈线性相关。上皮内瘤变、原位癌、浸润癌患者CEA水平比较差异未见统计学意义（P〉0.05），CA199水平比较差异有统计学意义，且上皮内瘤变患者CA199检测值处于正常范围。结论联合检测肿瘤标志物CEA、CA199比单项监测检出率更高、敏感性更高，CA199标志物水平与肿瘤的进展有一定的相关性，CEA甚至能在肿瘤处于异型增生时有一定的反应，故二者联合应用对结直肠癌早期的监测及早期诊断具有重要的意义，值得临床推广。

Objective To investigate the clinical significance of combined detection of serum carbohydrate antigen 199 （CA199） and carcinoembryonic antigen （CEA） in the early diagnosis of colorectal cancer.Methods The clinical data of 76 patients with colorectal cancer were collected. The levels of CEA and CA199 in serum of 76 patients with colorectal cancer were examined by chemiluminescence method; the diagnostic sensitivity, specificity and detection rates in the diagosis of colorectal cancer were compared between the CEA or CA199 alone method and the double indexes combination detection method; detection levels of CEA and CA199 in patients in different phases of colorectal cancer were compared; detection levels of CEA and CA199 in patients with intraepithelial neoplasia, carcinoma in situ and invasive carcinoma were compared.Results Compared with CEA and CA199 alone method, the sensitivity and detection rate of CEA and CA199 combination method were significantly higher （P〈0.05）. There was no significant difference in specificity and sensitivity between CEA alone method and CA199 alone method （all P〉0.05）. The detection rate of CEA alone method was significantly higher than that of CA199 alone method, and the difference was significant （P〈0.05）. There was no significant difference in CEA level between patients with Ⅰ, Ⅱ, Ⅲ and Ⅳ phase colorectal cancer （P〉0.05）. However, there was a significant difference in CA199 level between patients with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ colorectal cancer （P〉0.05）. The level of CA199 has linear correlation with the stage of cancer. There was no significant difference in CEA levels among patients with intraepithelial neoplasia, carcinoma in situ or invasive carcinoma （P〉0.05）, but there were significant differences in CA199 levels among patients with intraepithelial neoplasia, carcinoma in situ or invasion of cancer, and level of CA199 in patients with intraepithelial neoplasia was in the normal range.Conclusions Combined detection of tumor markers CEA and CA199 has higher detection rate and better sensitivity than single detection method, level of CA199 marker is related to tumor progression in a certain degree, CEA can even make response in the stage of tumor atypical hyperplasia, so the combination of the two markers of colorectal cancer has significance in early monitoring and early diagnosis of colorectal cancer, which is worthy of clinical promotion and reference.