胰腺癌早期诊断研究的现状与展望  

The current status and prospect of early diagnosis for pancreatic carcinoma

作　　者：李兆申[1] 

机构地区：[1]第二军医大学长海医院消化病研究所,上海200433

出　　处：《解放军医学杂志》2009年第1期7-9,共3页Medical Journal of Chinese People's Liberation Army

基　　金：国家科技支撑计划课题(2006BAI02A12);上海市自然科学基金资助项目(06ZR14013)

摘　　要：胰腺癌是一种严重危害人类健康的常见恶性肿瘤,其早期诊断和手术治疗可显著提高患者生存率,明显改善预后。近年来对胰腺癌的肿瘤标志物进行了大量研究,CA19-9、CA50、CA242、CA494等均是目前临床诊断胰腺癌的常用标志物,但迄今为止,仍未找到一种对早期胰腺癌有足够敏感性、特异性的肿瘤标志物来进行肿瘤筛查。一些细胞因子如转化生长因子(TGF)、巨噬细胞抑制因子-1(MIC-1)、可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管内皮细胞黏附因-1(sVCAM-1)和P选择素等在胰腺癌的诊断、治疗监测及预后评估中具有重要作用。B超检查具有简便、经济、无创、无痛的特点,是胰腺癌的首选诊断方法。单独选用CT、螺旋CT、磁共振胰胆管成像(MRCP)、超声内镜(EUS)等在胰腺癌的早期诊断上各有其优势与不足。采用逆行胰胆管造影(ERCP)收集胰液、刷取脱落细胞行细胞学、K-ras基因和端粒酶检查是胰腺癌早期诊断的发展方向。单独某项影像学检查或血清指标的特异性和敏感性尚不能满足临床诊断早期胰腺癌的需要,因此,需要寻找新的肿瘤标志物,并建立影像学、脱落细胞、癌基因、抑癌基因、端粒酶等联合诊断的方法来进一步提高胰腺癌的诊疗水平。Pancreatic carcinoma is one of the malignant tumors which is seriously harmful to the human health. Early diagnosis and operation of pancreatic carcinoma can significantly improve the survival rate and remarkably improve prognosis. Tumor markers have come into the research domain recent years such as CA19 9, CA50, CA242 and CA494. But none of tumor markers with sufficient sensitivity and specificity have been found to screen early panceatic carcinoma. Some cytokines including TGF, MIC-2, sICAM-1, sVCAM-1 and P-selectin play an important role in the diagnosis, therapy monitoring, and prognosis assessment of panceatic carcinoma. Being simple, convenient, economic, noninvasive and painless, B-ultrasound is the first choice of image diagnosis method for pancreatic carcinoma. Using CT, spiral CT, MR cholangio-pancreaticograph （MRCP） and endoscope ultrasound （EUS） alone has both advantages and disadvantages on diagnosing early pancreatic carcinoma. Detection of pancreatic juice, exfoliated cells, Kras oncogene and telomerase activity by endoscopic retrograde cholangio-pancreaticography （ERCP） will be the major tendency to early diagnose the pancreatic carcinoma. The image method or serum marker alone may be unfit for the early clinical diagnosis of pancreatic carcinoma since their low sensitivity and specificity. Therefore, it should be done to seek the new tumor markers, and establish the united diagnosis model including image, exfoliated cells, oncogene, tumor suppressor gene and telomerase activity to improve the levels of pancreatic carcinoma diagnosis and treatment.

关 键 词：胰腺肿瘤 早期诊断 肿瘤标记 生物学 癌基因 端粒 末端转移酶 

分 类 号：R735.9[医药卫生—肿瘤]