超声内镜联合三种血清肿瘤标志物诊断胰腺癌的价值分析

The analysis of the value of endoscopic ultrasonography combined with three serum tumor markers in the diagnosis of pancreatic cancer

目的探讨超声内镜(EUS)联合血清肿瘤标志物CA19-9、CA125、CEA诊断胰腺癌的应用价值。方法回顾性分析2013年1月至2014年5月浙江大学附属第一医院肝胆胰外科收治的胰腺肿瘤患者134例,其中胰腺癌89例,作为胰腺癌组;非胰腺癌45例,作为非胰腺癌组;另选取同期来该院进行健康体检者22例作为对照组。比较三组的血清肿瘤标志物CA19-9、CA125、CEA水平,以及胰腺癌组和非胰腺癌组的术前EUS与术后最终病理诊断结果。分析三种血清肿瘤标志物诊断胰腺癌的价值,尤其是EUS联合三种血清肿瘤标志物诊断胰腺癌的价值。结果胰腺癌组的血清CA19-9、CA125、CEA水平均明显高于非胰腺癌组和对照组,差异均有统计学意义(P均<0.05)。EUS联合CA19-9、CA125、CEA诊断胰腺癌的敏感度为89.89%、特异度为89.89%、阳性预测值为94.12%、阴性预测值为81.63%。EUS联合CA19-9、CA125、CEA诊断胰腺癌的结果与病理诊断结果一致性较好(kapp值0.771,P<0.001)。结论EUS联合CA19-9、CA125、CEA可以提高胰腺癌的诊断准确率,对胰腺癌的诊断和鉴别诊断具有重要指导价值。

Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS)combined with serum tumor markers CA19-9,CA125 and CEA in the diagnosis of pancreatic cancer.Methods From January 2013 to May 2014,134 cases of pancreatic tumor admitted to the Department of hepatobiliary and pancreatic surgery of the First Affiliated Hospital of Zhejiang University were analyzed,including 89 cases of pancreatic cancer as pancreatic cancer group,45 cases of non-pancreatic cancer were considered as nonpancreatic cancer group.In addition,22 cases who came to the hospital for physical examination in the same period were selected as the control group.The serum tumor markers CA19-9,CA125 and CEA levels in the three groups were compared,and the preoperative EUS and postoperative pathological findings in pancreatic cancer group and non-pancreatic cancer group were compared.Analyze the value of three serum tumor markers in the diagnosis of pancreatic cancer,especially the value of EUS combined with three serum tumor markers in the diagnosis of pancreatic cancer.Results The levels of serum CA19-9,CA125 and CEA in pancreatic cancer group were significantly higher than those in non-pancreatic cancer group and control group,with statistical significance(P all<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of EUS combined with CA19-9,CA125 and CEA in the diagnosis of pancreatic cancer were 89.89%,89.89%,94.12%and 81.63%respectively.The combination of endoscopic ultrasonography and CA 19-9,CA 125,CEA in the diagnosis of pancreatic cancer was highly consistent with pathologic results(Kapp=0.771,P<0.001).Conclusion EUS combined with CA19-9,CA125 and CEA can improve the diagnostic accuracy of pancreatic cancer,and has important guiding value for the diagnosis and differential diagnosis of pancreatic cancer.