燃煤型砷中毒患者血清肿瘤标志物临床意义  

Clinical significance of five serum tumor markers in patients with coalburning arsenic poisoning

作　　者：张涛 邹忠兰 周志 王江 葛建梅 王文娟[2] 张爱华[2] ZHANG Tao;ZOU Zhong-lan;ZHOU Zhi(Guiyang Municipal Public Health Clinical Center,Guiyang,Guizhou Province 550001,China)

机构地区：[1]贵阳市公共卫生救治中心,贵州550001 [2]贵州医科大学环境污染与疾病监控教育部重点实验室毒理学系

出　　处：《中国公共卫生》2019年第9期1257-1259,共3页Chinese Journal of Public Health

基　　金：国家自然科学基金重点项目(81430077;81730089)

摘　　要：目的分析燃煤型砷中毒患者血清中5项肿瘤标志物水平及临床意义,为砷中毒患者罹患肿瘤的早期发现提供依据。方法以贵州省雨樟燃煤型砷中毒病区为调查点,以186例砷中毒患者为对象,根据病情将其分为轻度砷中毒组(49例)、中度砷中毒组(66例)和重度砷中毒组(71例);同时选取非病区无燃用高砷煤史且生活习惯等与病区居民相似的63名居民作为对照组。知情同意下采集调查对象空腹外周静脉血;电化学发光免疫法检测血清中癌胚抗原(CEA)、甲胎蛋白(AFP)、非小细胞肺癌抗原(CYFRA21-1)、肿瘤相关抗原72-4(CA72-4)、糖类抗原199(CA19-9)5项肿瘤标志物。结果与对照组比较,各砷中毒组AFP和CYFRA21-1、CA72-4水平显著升高(P<0.05),中、重度砷中毒组CEA水平明显升高(P<0.05);与轻度砷中毒组比较,重度砷中毒组患者血清CEA和CYFRA21-1明显升高(P<0.05)。对照组人群血清CEA、AFP、CYFRA21-1、CA72-4、CA19-9阳性率分别为0%、1.59%、0%、3.17%、1.59%,砷中毒患者血清CEA、AFP、CYFRA21-1、CA72-4、CA19-9阳性率分别为16.13%、2.69%、24.73%、29.57%、9.14%;砷中毒患者血清中CEA、CYFRA21-1、CA72-4阳性率高于对照组,差异有统计学意义(P<0.05)。结论关注病区砷中毒患者中CEA和CYFRA21-1、CA72-4阳性人群,对砷中毒患者同时罹患肺脏、肝脏和胃等肿瘤的早期发现具有重要意义。Objective To analyze clinical significance of five serum tumor markers in patients with coal-burning arsenic poisoning and to provide evidences for early detection of cancer among arsenism patients. Methods In Yuzhang region of Guizhou province – an endemic area with coal-burning arsenic poisoning, we recruited 186 arsenism patients and divided them into a mild, moderate, and severe arsenism group (n = 49, 66, and 71);we also selected 85 non-arsenism residents in a non endemic region but with similar living habits to those of the arsenism patients as the controls. Fasting peripheral venous blood samples were collected among all the participants under informed consent for detections of serum carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), cytokeratin 19 soluble fragment (CYFRA21-1), carbohydrate antigen 72-4 (CA72-4), and carbohydrate antigen 199 (CA19-9) with electrochemiluminescence immunoassay. Results Compared with the those in the control group, AFP, CYFRA21-1, CA72-4, and CEA increased significantly in all arsenism groups (P < 0.05 for all), except for CEA in the mild arsenism group. In comparison with those in the mild arsenism group, serum CEA and CYFRA21-1 increased significantly in severe arsenism group (both P < 0.05). There was no significant difference in serum CA19-9 among the various groups (P > 0.05). The positive rates of CEA, AFP, CYFRA21-1, CA72-4, and CA19-9 were 0%, 1.59%, 0%, 3.17%, and 1.59% in the controls and those were 16.13%, 2.69%, 24.73%, 29.57%, and 9.14% in all the arsenism patients, respectively. The positive rates of serum CEA, CYFRA21-1, and CA72-4 were significantly higher in arsenism patients than those in the controls (P < 0.05 for all). Conclusion Serum CEA, CYFRA21-1, and CA72-4 may be of important significance for early detection of lung, liver and stomach tumors among residents with arsenism.

关 键 词：砷中毒 煤 肿瘤标志物 

分 类 号：R994.6[医药卫生—毒理学]