胰腺肿瘤伴血糖异常对肿瘤标志物的影响  

The effect of pathoglycemia on the tumor biomarker expression in pancreatic tumor

作　　者：李栋 齐晓光[2] 刘建安 任峰[3] 

机构地区：[1]上海市徐汇区大华医院消化内科,200237 [2]上海交通大学附属第六人民医院消化内科 [3]上海交通大学医学院附属瑞金医院普外科

出　　处：《中国综合临床》2011年第5期481-484,共4页Clinical Medicine of China

摘　　要：目的探讨血糖异常对胰腺肿瘤标志物在胰腺疾病诊断中的影响作用及其临床应用价值。方法以59例胰腺恶性肿瘤为研究对象，其中包括46例胰腺癌、13例胰腺其他恶性肿瘤，以27例良性疾病患者为对照，采集肿瘤患者术前静脉血，常规离心分离血清进行检测。利用美国雅培公司酶免发光分析仪器及配套试剂进行检测，诊断标准以CA199〉37kU／L、CA125〉35kU／L、癌胚抗原（CEA）〉10μg/L为阳性。结果（1）单项检测指标以CA199诊断准确性最高，两两联合检测以CA199＋CEA准确性最高，优于单项检测和三者联合，且经X^2检验差异具有统计学意义（x^2=26．131，P〈0．05）。三者联合诊断胰腺肿瘤，只会增加医疗费用，并不能提高诊断的准确性。（2）胰腺肿瘤组各指标平均秩次均高于胰腺良性疾病组，2组之间非参数检验结果如下：CA199（Z=4．682，P=0．000）、CA125（Z=1．866，P=0．062）、CEA（Z=2．573，P=0．010）；提示对于鉴别胰腺良恶性疾病，CA199、CEA等指标差异有统计学意义（Z=3．232，P〈0．05；Z=2．573，P=0．010）。（3）胰腺肿瘤患者中，血糖异常组与血糖正常组相比，非参数检验结果为CA199（Z=2．265，P=0．024）、CA125（Z=0．736，P=0．462）、CEA（Z=1．536，P=0．125），血糖异常只对CA199影响，差异有统计学意义（Z=2．265，P〈0．05）。而在胰腺良性疾病组患者中，差异均无统计学意义（分别为Z=4．214，P〉0．05；Z=3．224，P〉0．05；Z=3．154，P〉0．05）。结论对于胰腺肿瘤的诊断，三种肿瘤指标联合诊断，并不能提高诊断的准确性，只会增加医疗费用；以CA199＋CEA联合检测准确性最高；单项检测指标以CAl99诊断准确性最高。CA199在对伴有血糖异常的胰腺良恶性疾病的鉴别时，须考虑血糖的影响作用，通过ROC曲线设置不同的CA199调定点，有望达到更优的诊断效能。Objective To investigate the effect of pathoglycemia on the tumor biomarker expression in pancreatic tumor and assess its influence on the diagnostic value of these biomarkers. Methods We recruited 59 patients with malignant pancreatic tumor in total into this study, including 46 cases with pancreatic carcinoma and 13 cases with other pancreatic malignancies. Twenty-seven patients with benign panereatid diseases were selected as control. All subjects were extracted venous blood and serum samples were separated by centrifugation. Serum levels of CA199, CA125 and CEA were measured by chemiluminescent microparticle imnmnoassay（CMIA）. The positive expression criteria were designated as 〉 37 kU/L for CA199; 〉 35 kU/L for CA125 ; 〉 10 μg/L for CEA. Results （ 1 ） CA199 showed the highest diagnostic accuracy when the tumor biomarker was used alone. CA199 plus CEA showed the highest diagnostic accuracy when the biomarkers were used pairwisely, even better than three biomarkers used in combination （ X^2 = 26. 131, P 〈 0.05 ） . （ 2 ） The average rank of all tumor biomarkers were higher in all malignant pancreatic tumor than benign pancreatic diseases,and some of the differences reached statistically significance （ CA199, Z = 4. 682, P = 0. 000 ; CA125, Z = 1. 866, P = 0. 062 ; CEA, Z = 2. 573, P = 0. 010 ）. （ 3 ） When the malignant pancreatic tumor group were further divided into two groups according to their blood sugar level, we found that CA199 were significantly higher in pathoglycemia group than euglycemia group （ Z = 2. 265, P = 0. 024 ） , while no significant differences were observed in patients with benign pancreatic diseases when compared between patients with different blood sugar levels（ Z = 4. 214,3. 224,3. 154, Ps 〉 0. 05 ）. Conclusion The combination use of three tumor biomarkers showed no improvements in the diagnosis of pancreatic neoplasm, but with disadvantage of elevated medical expense. CA199 showed the highest diagnostic accuracy when used alone. CA199 plus CE

关 键 词：胰腺肿瘤 血糖异常 肿瘤标志物 

分 类 号：R735.9[医药卫生—肿瘤]