血清肿瘤标志物CEA和CA19-9联合检测在消化系统恶性肿瘤诊断中的临床价值评价  

The Clinical Value of Combined Detection of Serum Tumor Markers CEA and CA19-9 in digestive system malignancies Diagnosis

作　　者：赵磊[1] 武香玲[1] 

机构地区：[1]北京大学人民医院

出　　处：《中国病案》2009年第5期44-46,共3页Chinese Medical Record

摘　　要：目的评价并探讨血清肿瘤标志物CEA和CA19-9单项检测及联合检测在几种常见消化系统恶性肿瘤诊断中的临床价值。方法回顾性分析住院消化道疾病患者439例血清CEA、CA199单项检测和联合检测结果,以病理诊断为标准诊断,其中良性病变患者272例,恶性肿瘤患者167例。结果CEA与CA19-9联合检测使其各单检对消化系统恶性肿瘤诊断的灵敏度增加,尤其是对胆囊胆管癌、胰腺癌的诊断,CEA、CA19-9敏感性分别由单检的41.7%,83.%(胆囊胆管癌),55.6%,77.8%(胰腺癌)提高至联合检测时的91.7%(胆囊胆管癌),83.3%(胰腺癌);而联合检测的特异性有所降低。联合检测阳性似然比较单检中最高项目的阳性似然比降低;而联合检测的阴性似然比较单检的大部分降低,但对食管癌的诊断中联合检测的阴性似然比明显增加。结论肿瘤标志物CEA和CA19-9检测作为诊断性试验,在消化道恶性肿瘤的诊断中具有重要的价值,尤其是对胆囊胆管癌和胰腺癌;联合检测大大提高了胆囊胆管癌和胰腺癌的敏感性,可降低消化道恶性肿瘤筛选的漏诊率。Objective To evaluate and discuss the clinical value of single and combined detection of serum tumor makers with CEA and CA19 - 9 in several diagnosed malignancies in digestive system. Methods The single and combined detecting results of serum with CEA, CA199 in 439 patients with digestive tract diseases were retrospectively analyzed, the pathological diagnosis is the standard one, there are 272 benign and 167 malignant tumors among them. Results CEA and CA19 - 9 combined detection makes the sensitivity of diagnosis of malignant tumors increasing, especially for the diagnosis of gallbladder cholangioeareinoma, pancreatic cancer, the sensitivity has raised up from 41.7 %, 83.3 % （gallbladder cholangiocarcinoma）, 55.6%, 77.8% （pancreatic cancer）, by the single dictation, to 91.7% （gallbladder cholangiocareinoma）, 83.3% （pancreatic cancer）; however, the combined detection makes the specificity decreased. The positive likelihood ratio by the combined detection is lower than that of the highest single item; and the negative likelihood ratio is lower than that of the single one, but the positive likelihood ratio by the combined detection with esophageal cancer has significantly increased. Conclusions Tumor markers CEA and CA19 - 9 axe of an important value as a diagnostic test for malignant tumors in digestive tract, especially for the gallbladder bile duct and pancreatic cancer. The combined detection greatly improves the sensitivity of the gallbladder bile duct and pancreatic cancer, and can reduce the rate of missed diagnosis of gastrointestinal cancer.

关 键 词：CEA CA19-9 联合检测 消化系统恶性肿瘤 

分 类 号：R735[医药卫生—肿瘤]