血清碱性磷酸酶、癌胚抗原、糖类抗原19-9联合检测对胃癌骨转移的诊断价值

Diagnostic value of combined detection of serum alkaline phosphatase,carcinoembryonic antigen and carbohydrate antigen 19-9 in patients with bone metastasis of gastric cancer

目的探讨碱性磷酸酶(ALP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)单独与联合检测对胃癌骨转移的诊断价值,为胃癌骨转移的早期诊断提供依据。方法收集522例胃癌患者的临床资料及血清标志物(ALP、CEA、CA19-9)检测结果,根据有无骨转移将入组患者分为骨转移组(n=91)和无骨转移组(n=431)。参照Soloway分级标准将骨转移分为3级,进一步分析ALP、CEA、CA19-9三者单独与联合检测在胃癌骨转移中的诊断价值及其与骨转移分级之间的关系。结果骨转移组患者ALP、CEA、CA19-9水平均明显高于无骨转移组,差异均有统计学意义(P﹤0.01)。ALP、CEA、CA19-9均是胃癌发生骨转移的影响因素(P﹤0.05)。3种血清标志物联合检测的曲线下面积(AUC)大于任何指标单独检测,但ALP单独检测与三者联合检测的AUC值差异不明显;3种血清标志物联合检测诊断效能优于单独检测。ALP与CA19-9水平随着骨转移分级升高呈上升趋势。经Spearman相关分析显示,ALP、CA19-9与骨转移分级均呈正相关(r=0.436、0.391,P﹤0.05),且ALP在评价胃癌骨转移严重程度方面优于CA19-9。结论ALP、CEA、CA19-9联合检测对胃癌骨转移的诊断价值优于单项检测,为胃癌骨转移的早期诊断以及监测提供参考。但考虑到患者的经济因素,对于临床上怀疑胃癌骨转移的患者,ALP是首选的检测指标,且该指标可作为评价胃癌骨转移严重程度的生物学标志物。

Objective To explore the diagnostic value of serum alkaline phosphatase(ALP),carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)utilized alone or in combination in detecting gastric cancer with bone metastasis,so as to provide evidence for early diagnosis of bone metastasis in gastric cancer.Method The clinical data and serum markers(ALP,CEA,CA19-9)of 522 patients with gastric cancer were selected.The patients were divided into two groups according to the presence or absence of bone metastasis as bone metastasis group(n=91)and non-bone metastasis group(n=431).As per Soloway classification criteria,bone metastasis was classified as three grades,and the diagnostic value of ALP,CEA and CA19-9 alone and in combination in detecting bone metastasis of gastric cancer and the association with bone metastasis classification were further analyzed.Result The levels of ALP,CEA and CA19-9 in bone metastasis group were significantly higher than non-bone metastasis group(P<0.01).ALP,CEA,and CA19-9 were all factors influencing bone metastasis in gastric cancer(P<0.05).The area under the curve(AUC)of the combined detection of the three serum markers was larger than that of any indicator alone,though minor difference was noted for the AUC value of ALP alone versus that of the combined detection;the combined detection of three serum markers demonstrated higher diagnostic efficiency compared to each marker applied alone.The level of ALP and CA19-9 increased as the grading of bone metastasis evelated.Spearman correlation analysis showed that ALP and CA19-9 were positively correlated with bone metastasis grade(r=0.436,0.391,P<0.05),and ALP was of higher value in evaluating the severity of gastric cancer bone metastasis compared to CA19-9.Conclusion The combined detection of ALP,CEA and CA19-9 is superior to the three markers each used alone in the diagnosis of bone metastasis of gastric cancer,which provides reference for the early diagnosis and monitoring of bone metastasis.However,considering the economic burden in the perspective of patients with gastric cancer,ALP is the preferred detection index for patients with clinically suspected bone metastasis,and this index can be used as a biomarker to evaluate the severity of bone metastasis in gastric cancer.