老年人大肠癌诊断及随访中肿瘤标记物联合检测的价值

Value of combined assay of tumor markers in the diagnosis and follow-up of large intestinal cancer in the aged patients

目的 评价血清学肿瘤标记物对老年人大肠癌诊断和随访的价值。 方法 采用微粒酶免疫法检测 16 3例老年人大肠癌患者和 2 9例老年大肠良性疾病患者血清糖类抗原CA19 9、CA5 0、CA2 4 2及癌胚抗原的表达 ,对 4 2例行根治术的大肠癌患者进行随访。 结果 大肠癌患者血清糖类抗原CA19 9、CA5 0、CA2 4 2及癌胚抗原水平分别为 (45 2± 2 1 3)、(2 9 7± 17 6 )、(43 2± 37 6 ) μg/L和 (18 7± 12 4 ) μg/L ,均高于大肠良性疾病患者〔分别为 (8 4± 11 5 )、(7 7± 5 2 )、(9 1± 6 3) μg/L和 (2 5± 1 8) μg/L〕 ,并随病程进展逐渐增高 ;4种肿瘤标记物对诊断的敏感性与大肠癌的分期有关 ;平行联合检测可使诊断的敏感性提高至 83 5 % ,系列联合检测可使特异性提高至 88 7% ;肿瘤根治术后 ,肿瘤标记物显著下降 ;术后肿瘤标记物未降至正常者复发或转移率为 73 3% ,而术后再升高者复发或转移率为 85 2 %。 结论 上述 4种肿瘤标记物对老年人大肠癌的诊断和随访及监测肿瘤复发和转移有一定的价值。肿瘤标记物的联合检测有助于大肠癌早期诊断 。

Objective To evaluate the value of serum tumor markers in diagnosis and following up of large intestinal cancer(LIC) in the aged patients. Methods Serum CA19-9?CA50?CA242 and CEA in 163 aged patients with LIC and 29 aged patients with benign large intestinal diseases by micropartical enzyme immunoassay were examined,and 42 of them with radical operation was followed up. Results Serum levels of CA19-9?CA50?CA242 and CEA in patients with LIC were (45.2±21.3)μg/L, (29.7±17.6)μg/L, (43.2±37.6)μg/L, (18.7±12.4)μg/L and were significantly higher than those patients with benign large intestinal diseases〔 (8.4±11.5)μg/L, (7.7±5.2)μg/L, (9.1±6.3)μg/L and (2.5±1.8)μg/L〕, and the elevation was increased with the progress of LIC. The sensitivity of 4 tumor markers was related with the stages of LIC. Parallel combined testing methods increased the diagnostic sensitivity to 83.5%, and serial combined testing increased the diagnostic specificity to 88.7 %. The levels of serum tumor markers declined significantly after operation. The rate of recurrence or metastasis was 73.3% and 85.2% respectively in cases that the serum tumor markers were not decreased to normal level and reelevated after the operation. Conclusions Serum tumor markers show certain values in the diagnosis and the follow-up for LIC in the aged patients and can be used to monitor tumor recurrence and metastasis. The combined assay of tumor markers is helpful in the early diagnosis of LIC and increases the sensitivity and specificity in diagnosing LIC.