血清癌胚抗原和CA19-9对胃间质瘤的临床价值  

The diagnostic value of serum CEA and CA19-9 in gastric stromal tumors

作　　者：王玎[1] 董召刚[1] 王立水[1] 张建[1] 刘延红[1] 庄学伟[1] 张义[1] Wang Ding;Dong Zhaogang;Wang Lishui;Zhang Jian;Liu Yanhong;Zhuang Xuewei;Zhang Yi(Department of Clinical Laboratory,Qilu Hospital of Shandong University,Shandong Province Key Laboratories of Medicine and Health(Tumor Marker Translational Medicine Laboratory),Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院检验科,山东省医药卫生重点实验室(肿瘤标志物转化医学实验室),济南250012

出　　处：《中华检验医学杂志》2019年第2期128-134,共7页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金面上项目(81572070);山东省自然科学基金面上项目(ZR2017MH044);山东省重点研发计划(2016GSF201124,2016GSF201122,2016GSF201169)。

摘　　要：目的探讨肿瘤标志物癌胚抗原(CEA)、CA19-9、CA72-4、甲胎蛋白(AFP)、CA125在胃间质瘤辅助诊断中的应用价值。方法采用横断面研究,收集2014年5月至2017年12月间山东大学齐鲁医院住院的胃间瘤患者41例、胃平滑肌瘤患者11例,取组织进行HE染色、免疫组织化学染色法检测CD34、CD117、DOG-1表达。同期,自山东大学齐鲁医院体检中心选择41名健康志愿者。收集上述患者和健康志愿者血清,使用电化学发光法检测CEA、CA19-9、CA72-4、AFP、CA125水平。采用M-W检验或K-W检验比较各组差异,分析标志物与胃间质瘤临床参数的关系。绘制ROC曲线并计算曲线下面积(areaundercurve,AUC),计算胃间质瘤诊断临界值(cut-off值)及相应的敏感度、特异度、阳性预测值、阴性预测值。结果胃间质瘤患者组织HE染色镜下可见梭形细胞和/或上皮样细胞,CD34、CD117、DOG-1检测呈阳性。胃间质瘤患者血清CEA浓度为1.53(1.15,2.22)ng/ml,高于健康对照组1.06(0.62,1.48)ng/ml及胃平滑肌瘤患者0.79(0.39,1.39)ng/ml(U值分别为446.5、113.0,P均<0.05)。CA19-9在胃间质瘤组9.30(4.95,12.70)U/ml表达高于健康对照组6.62(4.56,8.82)U/ml(U=615.5,P<0.05)。AFP、CA125、CA72-4在3组之间表达差异无统计学意义(H值分别为4.348、1.073、3.897,P均>0.05)。CEA与胃间质瘤分期密切相关(U=129.0,P<0.05)。CA19-9与CEA对胃间质瘤的诊断效能比较,差异无统计学意义(P>0.05),二者联合可提高诊断效能,其灵敏度、特异度、阳性预测值、阴性预测值、曲线下面积分别为92.7%、48.8%、64.4%、87.0%、0.752。结论CEA与CA19-9联合检测对胃间质瘤有较好的敏感度和阴性预测值,有一定的辅助诊断价值。Objective To evaluate the diagnostic value of CEA,CA19-9,CA72-4,AFP,and CA125 in gastric stromal tumors.Methods41 patients with gastric stromal tumors and 11 patients with gastric leiomyoma were recruited in this study from Qilu Hospital of Shandong University during May 2014 to December 2017.The tissue was collected by surgery,and HE staining was done.Immunohistochemistry was employed to detect the expression of CD34,CD117,and DOG-1.Serum of all cases and 41 healthy volunteers in the same hospital were collected.The levels of CEA,CA19-9,CA72-4,AFP and CA125 were examined by electrochemiluminescence assay,and the differences in each group were compared by M-W test or K-W test.Then the relationship between those biomarkers and the clinical parameters of gastric stromal tumors was analyzed.Moreover,AUC(Area Under the curve),cut-off value,sensitivity,specificity,positive predictive value,negative predictive value with drawing ROC curve(receiver operating characteristic curve)were also calculated.ResultsSpindle cells or epithelioid cells were observed in the tissue of gastric stromal tumors.The expression of CD34,CD117,DOG-1 were positive.The level of the serum CEA 1.53(1.15,2.22)ng/ml in patients with gastric stromal tumor patients was higher than that in healthy controls 1.06(0.62,1.48)ng/ml and that in patients with gastric leiomyoma 0.79(0.39,1.39)ng/ml(the U value was 446.5,and 113.0 respectively,P<0.05).The level of CA19-9 in gastric stromal tumors 9.30(4.95,12.70)U/ml was higher than that in healthy controls 6.62(4.56,8.82)U/ml(the U value was 615.5,P<0.05).There were no significant differences in AFP,CA125,and CA72-4 of three groups(the H value was 4.348,1.073,and 3.897,P>0.05).Furthermore,the level of CEA was closely related to TNM stage(the U value was 129.0,P<0.05).The diagnostic value of CEA and CA19-9 was statistically not significant(P>0.05).However,the combination of two markers might increase diagnostic efficiency.The sensitivity,specificity,positive predictive value,negative predictive value and AUC

关 键 词：胃肿瘤 胃肠道间质肿瘤 癌胚抗原 CA-19-9抗原 

分 类 号：R735.2[医药卫生—肿瘤] R730.43[医药卫生—临床医学]