联合CA19-9、CA125和CEA检测在AFP阴性的ICC鉴别诊断中的应用价值  

Application of serum CA19-9, CA125 and CEA in diagnosis of serum AFP negative patients with intrahepatic cholangiocarcinoma

作　　者：张国柄[1] 徐江海[1] Zhang Guobing Xu Jianghai.(Department of Liver Disease, Fifth People＇sHospital, Anyang 455000, Henan Province, Chin)

机构地区：[1]河南省安阳市第五人民医院肝病六科,455000

出　　处：《实用肝脏病杂志》2017年第6期740-743,共4页Journal of Practical Hepatology

摘　　要：目的探讨血清癌抗原19-9(CA19-9)、癌抗原125(CA125)和癌胚抗原(CEA)联合检测在甲胎蛋白(AFP)阴性的肝内胆管细胞癌(ICC)患者诊断中的价值。方法 2014年6月~2016年6月我院收治的ICC患者60例,根据AFP检测结果,将其分为AFP阴性组和AFP阳性组,每组分别为30例。采用微阵列酶联免疫分析法(Array-ELISA)检测血清CA19-9、CA125和CEA,采用受试者工作特征曲线(ROC)下面积(AUC)分别对各标记物及联合检测诊断的灵敏度、特异度和正确率进行评估。结果 30例AFP阴性组血清CA19-9、CA125和CEA水平分别为138.8(85.7~185.1)U/ml、109.6(48.4~201.8)U/ml、11.2(17.5~21.9)ng/ml,均显著高于AFP阳性组的【(38.0(16.9~75.5)U/ml、18.1(9.3~48.1)U/ml、5.5(3.1~8.5)ng/ml),P<0.01】;两组血清肿瘤标志物诊断ICC的ROC曲线下面积均呈现出CA19-9>CA125>CEA的趋势,在AFP阴性组,各单项诊断的ROC曲线下面积分别为0.85、0.83和0.81,显著高于AFP阳性组的【(0.55、0.45和0.42),P<0.05】;在单项诊断ICC时,血清CA19-9、CA125和CEA的最佳临床诊断截断点分别为124.89 U/ml、96.04 U/ml和11.97 ng/ml;血清CA19-9、CA125和CEA诊断ICC的灵敏度、特异度和正确率分别为(73.33%、76.67%和71.67%)、(66.67%、70.00%和68.33%)和(60.00%、70.00%和65.00%),以CA19-9检测诊断的效能最高;两组联合检测诊断的ROC曲线下面积均高于单项指标检测的ROC曲线下面积,且都表现为(CA19-9/CA125/CEA)>(CA19-9/CA125)>(CA19-9/CEA)>(CA125/CEA),在AFP阴性组,各联合检测诊断的ROC曲线下面积分别为0.94、0.88、0.86和0.85,显著高于在AFP阳性组的【(0.74、0.62、0.58和0.52),P<0.05】;(CA19-9/CA125/CEA)、(CA19-9/CA125)、(CA19-9/CEA)和(CA125/CEA)四种联合检测诊断的灵敏度、特异度和正确率均提高,分别为(90.00%、90.00%和90.00%)、(83.33%、83.33%和81.67%)、(76.67%、83.33%和80.00%)和(70.00%、76.67%和73.33%),以CA19-9/CA125/CEA联合检测诊断效能最高。结论我们认为,血清CA19-9、CA125和CEA联合检�Objective To explore the application of serum cancer antigen19-9(CA19-9),CA125 and carcinoembryonic antige(CEA) in the diagnosis of serum alpha-fetoprotein(AFP) negative patients with intrahepatic cholangiocarcinoma(ICC). Methods 60 patients with ICC were recruited in our hospital between June 2014 and June 2016,and they were divided into two groups,e.g. AFP-negative group and AFP-positive group with 30 in each group according to the results of serum AFP detection. Serum CA19-9,CA125 and CEA levels were detected by array-ELISA. Receiver operating characteristic(ROC) curves were used to evaluate the diagnostic efficacy of each and joint detection of CA19-9,CA125 and CEA for diagnosis of ICC. R esults Serum levels of CA19-9,CA125 and CEA in AFP negative group were 138.8(85.7 ~185.1)U/ml,109.6(48.4 ~201.8)U/ml, 11.2(17.5 ~21.9)ng/ml,much higher than 【(38.0(16.9~75.5)U/ml,18.1(9.3~48.1)U/ml,5.5(3.1~8.5)ng/ml),P<0.01】 in AFP-positive group;The ROC curve area of serum CA19-9,CA125 and CEA in AFP negative group were 0.85,0.83 and 0.81,respectively,significantly higher than [(0.55,0.45 and 0.42),P<0.05] in AFP positive group; the cut-off-value ofserum CA19-9,CA125 and CEA in diagnosis of ICC were 124.89 U/ml,96.04 U/ml and 11.97 ng/ml respectively;The sensitivity,specificity and accuracy rates of CA19-9,CA125 and CEA were(73.33%,76.67% and 71.67%),(66.67%,70.00% and 68.33%) and(60.00,70.00% and 65.00),respectively;ROC curve area under joint detection showed that(CA19-9/CA125/CEA)>(CA19-9/CA125)>(CA19-9/CEA)>(CA125/CEA),the ROC curve area of joint diagnosis in the AFP negative group were 0.94,0.88,0.86 and 0.85,respectively,significantly higher than those in the AFP positive group [(0.74,0.62,0.58 and 0.52),P <0.05];the sensitivity,specificity and accuracy of joint detection [(CA19-9/CA125/CEA),(CA19-9/CA125),(CA19-9/CEA) and9 CA125/CEA)] increased,and they were(90%,90% and 90%),(83.33%,83.33% and 81.67%),(76.67%,83.33%and 80%) and(70%,76.67% and 73.33%),respectively,with the efficacy of(CA19-9/CA125/CEA) was the best

关 键 词：肝内胆管细胞癌 癌抗原19-9 癌抗原125 癌胚抗原 诊断 

分 类 号：R735.7[医药卫生—肿瘤]