肿瘤标记物联合检测在大肠癌诊断及随访中的价值

Value of combined assay of tumor markers in diagnosis and following up with large intestinal cancer

目的 评价血清学肿瘤标记物对大肠癌诊断和随访的价值。方法 采用微粒酶免疫法检测184例大肠癌和35例大肠良性疾病血清肿瘤标记物CA19-9、CA50、CA242及CEA的表达,并利用其对52例行根治术的大肠癌进行随访。结果 大肠癌病人4种肿瘤标记物水平高于大肠良性疾病病人,其水平随着大肠癌病程的进展逐渐增高;4种肿瘤标记物中以CA242敏感性和特异性最高,分别为52.6％和79.7％;4种肿瘤标记物对诊断的敏感性与大肠癌的分期有关;平行法联合检测可使诊断的敏感性提高至82.6％,系列法联合检测可使特异性提高至88.6％;根治术后,肿瘤标记物水平显著下降;根治术后肿瘤标记物水平至正常的病人复发或转移率为77.8％;根治术后肿瘤标记物水平重新升高者复发或转移率为84.8％。结论 血清肿瘤标记物CA19-9、CA50、CA242及CEA对大肠癌的诊断和随访有一定的价值,并可用于监测肿瘤复发和转移。肿瘤标记物的联合检测有助于大肠癌的早期诊断,并可增加诊断的敏感性和特异性。

Objective To evaluate the value of serum tumor markers in diagnosis and following up with large intestinal cancer. Methods Detecting serum tumor markers CA19-9.CA50.CA242 and CEA in 184 patinets with large intestinal cancer and 52 patients with benign large intestinal diseases by micropartical enzyme immunoassay (MEIA) ,and utilizing these markers to follow up with 52 patients with radical operation. Results Serum levels of 4 tumor markers in patients with large intestinal cancer were significantly higher than those in patients with benign large intestinal diseases and elevated gradually a-long with the course of large intestinal cancer. CA242 was the best diagnostic index among these tumor markers, its sensitivity and specificity were 52.6% and 79.1% respectively.The sensitivity of 4 tumor markers was related with the stages of large intestinal cancer.Method of parallel combined testing could increase the diagnostic sensitivity to 82.6% ,and serial combined examination could increase the diagnostic specificity to 88.6% . The levels of serum tumor markers declined significantly after radical operation. The rate of recurrence or metastasis was 77.8 % in patients that the levels of serum tumor markers were not decreased to normal after radical operation. The rate of recurrence or metastasis was 84.8 % in patients that the levels of serum tumor markers were reelevated after radical operation. Conclusions Serum tumor markers have certain value in the diagnosis and the follow-up for large intestinal cancer and can be used to monitor tumor recurrence and matastasis. The combined assay of tumor markers is helpful to early diagnosis of large intestinal cancer and could increase the sensitivity and specificity in diagnosing large intestinal cancer.