血清唾液酸在肝癌患者诊疗中的临床应用  

The clinical significance of serum sialic acid detection for diagnosis and therapy monitoring in livercancer patients

作　　者：王慜杰[1] 严翠娥[1] 李学祥[1] 胡书生[1] 韩晓红[1] 齐军[1] 

机构地区：[1]中国医学科学院肿瘤医院检验科,北京100021

出　　处：《中华检验医学杂志》2013年第7期643-647,共5页Chinese Journal of Laboratory Medicine

基　　金：首都医学发展基金资助项目（2009-3008）;北京希望马拉松专项基金资助项目（LC2010817）

摘　　要：目的评价血清唾液酸（SA）在肝癌诊断和疗效监测中的临床价值。方法用罗氏P800全自动分析仪检测2011年1月至2012年10月中国医学科学院肿瘤医院就诊的221例肝癌（原发性肝癌183例，转移性肝癌38例）、117例肝良性疾病患者和150名健康人血清SA含量；采用高、低两个浓度的样本，每日测量4次，连续测量5d，评价SA试剂盒的批内和批问变异系数（CV）；用183例原发性肝癌和150名健康人血清SA检测数据绘制受试者工作曲线（ROC曲线）确定SA的临界值，并评价SA的诊断价值。同时，对103例肝癌患者治疗前和治疗后1、7、14d和1、3、6、9个月的SA水平进行追踪监测和评价分析。采用SPSSl6．0进行统计分析。结果低浓度水平样本的批内和日间变异分别为2．4％和3．2％；高水平样本的批内和日间变异分别为2．2％和3．1％。用ROC曲线确定SA的临界值为659mg／L，用其诊断肝癌的敏感度和特异度分别为63．4％（116／183）、94．7％（142／150）。肝癌患者血清SA水平[（726±173）mg／L]明显高于肝良性疾病组[（552±128）mg／L]和健康对照组[（599±62）mg／L，U值分别为1832．52和887．00，P〈0．01]。随访103例原发性肝癌患者，其血清SA水平在治疗后1周升高[（817±193）mg／L，t=-3．272，P〈0．05]；持续到治疗后1个月[（782±173）mg／L，t=-2．694，P〈0．05]；在第3个月时，SA降低至治疗前水平[（662±138）mg／L，t=1．225，P〉0．05]；第6个月时降低至[（615±144）mg／L，t=1．999，P〈0．05]，接近健康对照组水平；有85例肝癌患者SA水平与治疗前相比降低，与临床病情的符合率为82．5％（85／103，Kappa值0．79）。有5例肝癌患者在治疗后第9个月复发，SA水平明显增高[（939±175）mg／L]。结论血清sA对肝癌的辅助诊断和疗效监测可能有临床价值。Objective To investigate the clinical significance of the serum sialic acid （SA） detection for the diagnosis and therapy monitoring in liver cancer patients. Methods Patients and healthy people of Chinese academy of medical science cancer hospital from January 2011 to October 2012, were enrolled, including 221 liver cancer patients （183 primary hepatic carcinoma patients and 38 metastatic hepatic carcinoma patients） , 117 benign liver disease patients and 150 healthy people. The concentration of serum SA were tested by ROCHE P800. The intra-assay and inter-assay coefficient of variation （CV） of SA kit were evaluated by use of low and high concentration samples, measured for 5 days and 4 times each day. Receiver operating characteristic （ROC） curve were used to determine the cut-off of SA using data of 183 cases of primary liver cancer and 150 healthy controls. The area under the curve （ROC-AUC） were used to evaluate the diagnostic value of SA. The changes of serum SA level in 103 cases of primary hepatic carcinoma patients were monitored before therapy and at the 1 st day, 7 th day, 14 th day, 1 st month, 3rd month ,6 th month and 9 th month after treatment. SPSS16.0 was used to analyse the results. Results The intra and inter-day CVs for low level sample were 2.4% and 3.2% respectively, and for high level sample were 2. 2% and 3.1%. The cut-off value of the serum SA was 659 mg/L for fiver cancer, the sensitivity andspecificity was 63.4% （ 116/183 ） and 94. 7% （142/150） respectively. The serum SA level of liver cancer group [ （726±173） mg/L] was higher than that of liver benign disease patients group [ （552 ± 128 ） mg/ L] and healthy controls group [ （599 ± 62） mg/L, U values were 1832.52 and 887.00, P 〈 0. 01 ]. The serum SA level were tracked in 103 cases of primary hepatic carcinoma patients during therapy period. The serum level of SA elevated to [（817 ±193） mg/L,t = -3. 272, P 〈0. 051 at 1 st week after treatment and kept at high level until late in 1st mon

关 键 词：肝肿瘤 肿瘤标记 生物学 N-乙酰神经氨酸 

分 类 号：R512.62[医药卫生—内科学]