血清CA19-9、CA50、CA242、CA125及CEA联合检测在Ⅰ～Ⅲ期可切除胰腺癌中的临床应用价值  

Clinical application value of combined detection of serum CA19-9, CA50, CA242, CA125 and CEA in stage Ⅰ～Ⅲ resectable pancreatic cancer

作　　者：诸静文[1] 张洁 叶柳青[3] 丁金旺 周国明[3] 陆军 李克桑 ZHU Jingwen;ZHANG Jie;YE Liuqing;DING Jinwang;ZHOU Guoming;LU Jun(Zhejiang Cancer Hospital,Hangzhou 310022,Zhejiang,China)

机构地区：[1]宁波市第二医院,宁波315010 [2]西藏民族大学医学部基础医学院 [3]浙江省肿瘤医院 [4]杭州市第一人民医院(南京医科大学附属杭州医院)

出　　处：《现代实用医学》2018年第9期1128-1130,1215,共4页Modern Practical Medicine

基　　金：国家自然科学基金青年项目(81602703);杭州市"131"人才计划

摘　　要：目的探讨血清癌抗原19-9(CA19-9)、癌抗原50(CA50)、癌抗原242(CA242)、癌抗原125(CA125)及癌胚抗原(CEA)联合检测在Ⅰ～Ⅲ期可切除胰腺癌中的临床应用价值。方法采用化学发光法(CLIA)检测394例可手术胰腺肿物(202例Ⅰ～Ⅲ期可切除胰腺癌和192例胰腺良性疾病)患者血清中CA19-9、CA50、CA242、CA125和CEA表达水平,比较上述5项血清标志物在良恶性胰腺肿物、不同胰腺癌分期及手术前后的表达差异,构建ROC曲线并计算AUC值及各项标记物的诊断评价指标。结果Ⅰ～Ⅲ期胰腺癌组的血清CA19-9、CA50、CA242、CA125和CEA的表达水平明显高于胰腺良性疾病组(均P<0.05),在202例可切除胰腺癌中,随着胰腺癌TNM分期增加,各血清标志物表达水平逐渐升高(均P <0.05),而且术后1周上述血清标志物均有显著下降(均P <0.05)。单项检测时,血清CA19-9、CA50、CA242、CA125和CEA诊断可切除胰腺肿物良恶性质的AUC分别为0.839、0.824、0.776、0.675、0.693,敏感性分别为72.28%、65.35%、48.51%、36.73%、39.60%,特异性分别为94.27%、95.83%、97.92%、89.58%、85.42%;5项联合检测时,诊断AUC为0.890,敏感性为84.15%、特异性分别为95.31%,总体诊断效果优于各单一指标。结论血清CA19-9、CA50、CA242、CA125和CEA联合检测有助于Ⅰ～Ⅲ期可切除胰腺癌的临床诊断、病情评估和疗效监测,值得临床推广。Objective To explore the clinical application value of CA19-9, CA50, CA242, CA125 and CEA in re- sected stage Ⅰ～Ⅲ pancreatic carcinoma. Methods The expression differences of the above five serum markets in benign and malignant pancreatic masses, different pancreatic cancer stages, and before and aiteT surgery were com- pared. The ROC curve was constructed and the AUC value and the diagnostic evaluation index of each market were calculated.Results The serum levels of CA19-9, CA50, CA242, CA125 and CEA in resected stage Ⅰ～Ⅲ pancreatic cancer group were significantly higher than those in the control group （all P 〈 0.05）.As the pathological stages of pancreatic carcinoma increased,the serum levels of CA19-9, CA50, CA242, CA125 and CEA were significantly ele- vated （allP 〈 0.05）. Moreover, the serum levels of above five tumor markers at one week after operation were sig- nificantly decreased,compared with those ofpreoperation（allP 〈 0.05）. For single assay, the AUC of serum CA19-9, CA50, CA242, CA125 and CEA were 0.839, 0.824, 0.776, 0.675and 0.693, while the diagnostic sensitivity of above five serum markers was 72.28%, 65.35%, 48.51%, 36.73% and 39.60%, and the diagnostic specificity was 94.27%,95.83%,97.92%,89.58% and 85.42%, respectively. For combination detection, the diagnostic value of serum CA19-9, CA50, CA242, CA125 and CEA was better than any of them alone, with the AUC of 0.890,the sensitivity of 84.15%, and the specificity of 95.31%. Conclusions Combination detection ofserttm CA19-9, CA50, CA242, CA125 and CEA has important clinical value in diagnosis, staging and monitoring ofresected stage Ⅰ～Ⅲ pancreatic carcinoma.

关 键 词：胰腺癌 肿瘤标志物 手术 诊断 分期 疗效 

分 类 号：R735.9[医药卫生—肿瘤]