胰腺癌临床预警指标和筛查方案研究  

Establishment of Screening Model Based on Study of Clinical Predicting Marker for Pancreatic Cancer

作　　者：陆星华[1] 王丽[2] 杨爱明[1] 钱家鸣[1] 李辉[2] 麦灿荣[1] 钟守先[1] 邓瑞雪[1] 周璐[1] 杨晓鸥[1] 蒋卫君[1] 

机构地区：[1]中国协和医科大学/中国医学科学院北京协和医院,100730 [2]中国协和医科大学/中国医学科学院基础研究所流行病教研组,100005

出　　处：《医学研究通讯》2005年第10期9-12,共4页Bulletin of Medical Research

基　　金：卫生部直属医疗机构临床学科重点基金资助(20010102)

摘　　要：目的探索胰腺癌的预警指标,建立筛查方案。方法于1996年10月～2000年6月及2002年2月～2004年3月采用以医院为基础病例对照研究,对胰腺癌患者270例,胰腺良性疾病131例,非胰腺癌良性消化道疾病191例,正常人272例,进行各种影像检查(包括 B 超、CT、ERCP、EUS、DSA)和实验室检查(包括血 CA199和 CA242、大便 K-ras、p53,胰液、十二指肠液 K-ras 突变检测)进行评估。结果胰腺癌影像诊断中 EUS 及 ERCP 具有最高准确性,K-ras 在胰腺癌胰液中突变率为84.4%,十二指肠液中为83.3%,大便中为83.3%,肿瘤标志物 CA199和 CA242诊断胰腺癌敏感性分别为78.4%和68.3%。结论大便 K-ras、CA199、US 的联合试验可使敏感性提高,作为第一步胰腺癌筛选指标,如果可疑则进行 CT 检查,EUS 和 ERCP 等有创伤性检查作为第三步。Objective To investigate the clinical predictable marker and screening model of pancreatic cancer. Methods 270 pancreatic cancer cases diagnosed between 1996 - 2000 and 2002 - 2004 were analyzed by using information a case control method collected from, including imaging examination such as US, CT, ERCP, EUS, DAS and laboratory test such as CA199, CA242. The mutation of K - ras in pancreatic juice, intestinal juice and stool were determined to establish a screening model. Results EUS and ERCP were effective imaging tests for detecting abnormal pancreatic masses. The mutation of K - ras was found in pancreatic juice, intestinal juice and stool in 84.4%, 83.3% and 83.3% of pancreatic cancer patients respectively. Tumor marker CA199 was also seen in 78.4% of pancreatic cancer patients. Conclusion K- ras and p53 mutation combined with CA199 were recommended as the primary tests in screening pancreatic cancer patients. EUS and ERCP were consid- erod only for the patients with inconclusive CT studies or normal CT results when symptoms nevertheless suggested the pancreatic cancer.

关 键 词：胰腺癌 临床预警指标 筛查方案 实验室检查 

分 类 号：R735.9[医药卫生—肿瘤] R730.4[医药卫生—临床医学]