肿瘤标志物对老年人肿瘤筛查的临床价值分析  

Tumor Markers:A Clinical Value Analysis in Elderly Cancer Screening

作　　者：张勰义[1] 成园 杜兆辉 汪海娅[2] 方宁远[2] 

机构地区：[1]上海市浦东新区潍坊社区卫生服务中心,200122 [2]上海交通大学医学院附属仁济医院老年医学科

出　　处：《中国全科医学》2014年第23期2757-2760,共4页Chinese General Practice

摘　　要：目的：评估多种血清肿瘤标志物在老年人肿瘤筛查中的应用价值，并分析其在老年人与年轻人肿瘤筛查中的差异。方法采用随机数字表法选择2010年10月-2012年10月在上海交通大学医学院附属仁济医院浦东分院进行健康体检的61例老年人（老年人组，年龄≥60岁）和67例年轻人（年轻人组，年龄〈60岁）的体检结果，获取两组体检者的血清肿瘤标志物检查结果。血清肿瘤标志物包括甲胎蛋白（ AFP ）、癌胚抗原（ CEA ）、糖链抗原（CA）199、CA50、CA724、CA211、前列腺特异抗原（PSA），对比分析两组血清肿瘤标志物的阳性率及水平。将老年人组按照年龄又分为低龄亚组（60-74岁，29例）和高龄亚组（≥75岁，32例），分析两年龄亚组各血清肿瘤标志物水平的差异。结果老年人组检出11例恶性肿瘤患者，3例肺癌患者CA211阳性、1例直肠癌患者CEA阳性、1例前列腺癌患者PSA阳性；年轻人组检出4例恶性肿瘤患者，仅1例肝癌患者AFP阳性。老年人组肿瘤检出率高于年轻人组（χ2=4.491，P〈0.05）。老年人组CEA、CA211、PSA阳性率高于年轻人组，老年人组CEA、CA211、PSA水平高于年轻人组，老年人组AFP水平低于年轻人组（P〈0.05）。老年人组中低龄亚组CEA和CA724水平高于高龄亚组， PSA水平低于高龄亚组（ P〈0.05）。结论仅依靠血清肿瘤标志物对肿瘤进行筛查容易导致恶性肿瘤的漏诊。在老年人中发现CEA、CA211、PSA阳性较年轻人更具诊断价值。CEA、CA724、CA211和PSA的参考值可能因年龄的不同而有差异，应设置针对不同年龄人群的肿瘤标志物参考值。Objective To evaluate the value of tumor markers in elderly cancer screening and study the difference be-tween the elderly and young people. Methods The results of physical examinations（PE）of 61 elderly（age≥60）and 67 young（age〈60）people having PE from October 2010 to October 2012 were drawn randomly to acquire the results of serum tumor markers,including alpha fetoprotein（ AFP）,carcino -embryonic antigen（ CEA）,carbohydrate antigen（ CA）199, CA50,CA724,CA211,prostate specific antigen（PSA）. The positive rate of tumor markers and their positive rates were ana-lyzed comparatively. The elderly group were divided,according to age,into subgroups low age（60 -74,n=29）,advanced age（≥75,n=32）,and the difference in tumor marker were analyzed between 2 subgroups. ResUlts In elderly group,11 had malignant tumor,3 lung cancer patients had positive CA211,1 colorectal cancer patient had positive CEA,1 prostate canc-er patient had positive PSA;in young people group,4 had malignant tumor,only 1 liver cancer patient had positive AFP. The tumor detection rate was higher in elderly group than in young people group（χ2 =4. 491,P 〈0. 05）. The positive rates of CEA,CA211,PSA were higher,levels of CEA,CA211,PSA higher,AFP level lower in elderly group than in young people group（P〈0. 05）. The levels of CEA,CA724 were higher,PSA lower in low age subgroup than in advanced age subgroup（P〈0. 05）. ConclUsion Only relying on tumor markers to screen cancers may lead to misdiagnosis of malignant tumor. Positive CEA,CA211,PSA are of more diagnostic values in elderly than in young people. The reference values of CEA,CA724, CA211,PSA may vary by age. Reference values of tumor markers should be set for different age groups.

关 键 词：肿瘤标记 生物学 健康调查 老年人 

分 类 号：R73-051[医药卫生—肿瘤]