肿瘤标志物CEA、CA19-9在消化系统恶性肿瘤检测的临床意义  

The Diagnostic Value of CEA and CA19-9 in Malignant Diseases of Digestive System

作　　者：刘瑾[1] 白杨娟[1] 王兰兰[1] 

机构地区：[1]四川大学华西医院临床免疫实验室,四川成都610041

出　　处：《华西医学》2008年第2期334-336,共3页West China Medical Journal

摘　　要：目的:以病理切片诊断为金标准,回顾性分析和评价肿瘤标志物CEA和CA19-9在消化系统常见肿瘤中的诊断效率和临床意义。方法:应用电化学发光免疫分析法,测定消化系统272例恶性肿瘤及167例良性疾病患者血清中的CEA和CA19-9含量,对其敏感性、特异性、准确性、阳性预测值和阳性似然比进行分析。结果:单检CEA和CA19-9诊断消化系统恶性肿瘤的敏感性分别为34.2%和45.2%,联检49.3%,特异性为80.8%和60.5%,联检59.3%,准确性由单检的51.9%(CEA)和51.0%(CA19-9)提高至联检的53.1%。本实验测定方法的变异系数<3%,方法重复性好。在消化系统常见肿瘤中,CEA诊断胰腺癌的敏感性最高(55.6%),胆囊胆管癌和结直肠癌次之,分别为41.7%和41.6%;其特异性在胆囊胆管癌最高(88.2%),肝癌次之(85.0%);其阳性预测值以食道癌最高(88.9%),胰腺癌次之(83.3%);阳性似然比以胆囊胆管癌最高,为3.5。CA19-9诊断胆囊胆管癌敏感性最高(83.3%),胰腺癌和肝癌次之,分别为77.8%和69.8%;特异性以胰腺癌和食道癌最高,均为75.0%;阳性预测值以胰腺癌最高(87.5%),结直肠癌次之(75.6%);阳性似然比以胰腺癌最高,为3.1。结论:除胃癌、食道癌外,CA19-9的敏感性均高于CEA,并且联合检测可提高敏感性和准确性,是协助早期实验室诊断消化系统恶性肿瘤的有效方法。Objective：To analyze and evaluate retrospectively the diagnostic value and clinical significance of tumor markers as CEA and CA19-9 in tumors of digestive system,all defined by pathology.Methods：The serum content of these tumor markers was measured in 272 tumors of digestive system,and 167 benign diseases with electrochemiluminescence immunoassay（ECLIA） and compared their sensitivity,specificity,accuracy,positive predictive value（PPV） and positive likelihood ratio（LR＋） were analyzed.Results：The sensitivity of CEA and CA19-9 to diagnose tumors of digestive system was 34.2% and 45.2% respectively and 49.3% in combination,while the specificity was 80.8% and 60.5% respectively and 59.3% in combination.The accuracy increased from 51.9%（CEA） and 51.0%（CA19-9） to 53.1%（CEA and CA19-9）.The CV of the method was less than 3%,so the repetition was good.The sensitivity of CEA to diagnose pancreatic carcinoma was highest（55.6%）,and a bit higher for carcinoma of gallbladder and bile duct（41.7%） as well as colorectal carcinoma（41.6%）;the specificity was highest in carcinoma of gallbladder and bile duct（88.2%） and that of liver cancer was 85.0%;the PPV of cancers of esophagus was highest（88.9%） and pancreatic carcinoma was second highest（83.3%）;the LR＋ was highest in carcinoma of gallbladder and bile duct（3.5）.On the other hand,the sensitivity of CA19-9 to diagnose carcinoma of gallbladder and bile duct was much higher than that of any other tumor（83.3%） and that of pancreatic carcinoma and liver cancer was 77.8% and 69.8% respectively;the specificity was highest in pancreatic carcinoma and cancers of esophagus（75.0%）;the PPV of pancreatic carcinoma and colorectal carcinoma was 87.5% and 75.6%;whereas the LR＋ was highest in pancreatic carcinoma（3.1）.Conclusion：Except for cancers of stomach and esophagus,the sensitivity of CA19-9 is higher than that of CEA.It indeed improves the sensitivity and accuracy in diagnosing tumors of digestive system by measur

关 键 词：CEA CA19-9 电化学发光免疫分析 消化系统 良恶性疾病 

分 类 号：R735[医药卫生—肿瘤]