DCIS患者外周血CTC、CA125、CA153、CEA水平检测及临床意义

Detection and clinical significance of peripheral blood circulating tumor cells,serum carbohydrate antigen 125,serum carbohydrate antigen 153,carcinoembryonic antigen levels in patients with ductal carcinoma in situ

目的研究乳腺导管原位癌(DCIS)患者外周血循环肿瘤细胞(CTC)、血清糖类抗原153(CA153)、血清糖类抗原125(CA125)、癌胚抗原(CEA)水平变化及临床意义。方法选择2020年1~10月陕西省核工业二一五医院收治的155例乳腺良性病变患者设为良性组,85例DCIS患者设为恶性组,另选择同时期在我院体检的150例健康者设为对照组。采用免疫荧光原位杂交技术(IMFISH)检测所有受试者的CTC水平,并采用电化学发光法检测所有受试者的CA153、CA125和CEA水平。比较各组受试者的CTC、CA153、CA125及CEA水平,以及各项指标单独检测和联合检测的阳性率,比较单独检测和联合检测对DCIS的灵敏度、特异度和符合率。结果恶性组患者的CTC、CA153、CA125、CEA水平分别为(3±1)个、(14.62±2.88)U/mL、(14.48±1.52)U/mL、(4.49±1.14)ng/mL,明显高于良性组的0个、(8.54±1.79)U/mL、(11.38±1.20)U/mL、(2.34±0.68)ng/mL和对照组的0个、(7.35±1.26)U/mL、(11.04±1.01)U/mL、(2.27±0.48)ng/mL,差异均有统计学意义(P<0.05);恶性组患者的CTC、CA153、CA125、CEA四项指标单独检测和联合检测的阳性率分别为50.59%、16.47%、18.82%、20.00%、68.24%,明显高于良性组的1.29%、3.23%、4.52%、1.29%、10.32%和对照组的0、1.33%、2.00%、1.33%、3.33%,差异均有统计学意义(P<0.05);恶性组和良性组联合检测的阳性率明显高于四项指标单独检测,差异有统计学意义(P<0.05),且恶性组不同检测方法之间的阳性率比较,差异有统计学意义(P<0.05),但对照组不同检测方法之间的阳性率比较差异无统计学意义(P>0.05);CTC检测对DCIS的灵敏度、特异度和符合率分别为50.86%、99.34%和88.72%,CA153检测为16.38%、97.70%和80.00%,CA125检测为18.97%、96.72%和79.74%,CEA检测为20.69%、98.69%和81.28%,联合检测为68.97%、93.11%和87.69%,各种检测方法的灵敏度、特异度和符合率总体比较差异均有统计学意义(P<0.05)。结论CTC、CA153、CA125及CEA可以作为乳腺导管原位癌患者的有效检测指标,且上述四项指标联合检测的灵敏度和符合率更高,有助于乳腺导管原位癌的鉴别和早期诊断,具有推广价值。

Objective To study the changes in the levels of circulating tumor cells(CTC),serum carbohydrate antigen 153(CA153),serum carbohydrate antigen 125(CA125),and carcinoembryonic antigen(CEA)in patients with ductal carcinoma in situ(DCIS)and clinical significance.Methods A total of 155 patients with benign breast lesions diagnosed and treated in the 215^(th) Hospital of Shaanxi Nuclear Industry from January 2020 to October 2020 were selected as the benign group,85 patients with DCIS as the malignant group,and 150 healthy persons who underwent physical examination in our hospital at the same time were selected as the control group. Immunofluorescence in situ hybridization(IMFISH) was used to detect the levels of CTC in all subjects, and the electrochemiluminescence method was used to detectthe values of CA153, CA125, and CEA in all subjects. The test levels of CTC, CA153, CA125, and CEA of thesubjects in each group were compared, as well as the positive rates of individual tests and combined tests (CTC+CA153 +CA125 +CEA), and the sensitivity, specificity, and coincidence rate of various detection methods to DCISwere compared. Results The levels of CTC, CA153, CA125, and CEA in malignant group were 3±1, (14.62±2.88) U/mL,(14.48±1.52) U/mL, and (4.49±1.14) ng/mL, which were significantly higher than 0, (8.54±1.79) U/mL, (11.38±1.20) U/mL,(2.34±0.68) ng/mL in benign group, and 0, (7.35±1.26) U/mL, (11.04±1.01) U/mL, (2.27±0.48) ng/mL in control group(P<0.05). The positive rates of CTC, CA153, CA125, CEA and combined tests in malignant group were 50.59% ,16.47%, 18.82%, 20.00%, and 68.24% respectively, which were significantly higher than 1.29%, 3.23%, 4.52%, 1.29%,10.32% in benign group and 0, 1.33%, 2.00%, 1.33%, 3.33% in control group (P<0.05). The positive rate of combinedtests in malignant group and benign group was significantly higher than that of four indexes alone, with statistically significantdifferences (P<0.05);there were significant differences in the positive rate between different detection methodsin malignant group (P<0.05), but there was no significant difference in the positive rate between different detection methodsin control group (P>0.05). The sensitivity, specificity, and coincidence rate of CTC detection for DCIS were 50.86%,99.34% and 88.72%, respectively, 16.38%, 97.70%, and 80.00% of CA153 detection, with CA125 detection for 18.97%,96.72%, and 79.74% of CA125 detection, 20.69.%, 98.69%, and 81.28% of CEA detection, and 68.97%, 93.11%, and87.69% of combined tests. The sensitivity, specificity and coincidence rate of various detection methods were compared,and the differences were statistically significant (P<0.05). Conclusion CTC, CA153, CA125 and CEA can be used as effectivedetection indicators for patients with DCIS, and the sensitivity and coincidence rate of the combined detection ofthese four indicators are higher, which is helpful for the identification and early diagnosis of ductal carcinoma in situ andhas promotion value.