外周血cfDNA和癌抗原分子标志物对早期胃癌的诊断价值  

The diagnostic value of peripheral blood cfDNA and molecular markers of cancer antigen for early gastric cancer

作　　者：向华[1] 施莉[1] 施晓英[1] 傅怡悦 傅思华 胡翌晨 吴佳佳 Xiang Hua

机构地区：[1]浙江省金华市人民医院,3210000

出　　处：《浙江临床医学》2025年第2期166-168,共3页Zhejiang Clinical Medical Journal

基　　金：金华市公益性技术应用研究项目(2023-4-104)。

摘　　要：目的探讨血浆游离DNA(cfDNA)检测在胃癌早期诊断中的临床价值,并阐明cfDNA与血清肿瘤标志物联合检测在胃癌早期诊断中的临床应用价值。方法纳入180例有胃疾病的患者,根据年龄分为3组:<35岁,35~55岁,>55岁,随机选取90例患者进行外周血cfDNA检测。所有患者均接受胃镜检查和活组织病理检测,并检测糖类抗原125(CA-125)、癌胚抗原(CEA)和糖类抗原19-9(CA19-9)。比较各年龄段患者胃组织病理检测差异,不同病理组间cfDNA差异,以及cfDNA、CEA、CA-125和CA19-9单独检测及联合检测对早期胃癌诊断敏感度、特异度和诊断效能。结果随着年龄增大,胃癌前病变及早期胃癌发病率逐渐升高(P<0.05)。早期胃癌患者cfDNA水平显著高于胃癌前病变组及正常组(0.3995 VS.0.1586 ng/μL,0.3995 VS.0.0250 ng/μL,P<0.01)。胃癌前病变组cfDNA水平高于正常组(0.1586 VS.0.0250 ng/μL,P<0.05)。cfDNA在早期胃癌中的阳性率高于胃癌前病变组及正常组(75.65%VS.52.52%;75.65%VS.50.68%,P<0.05),而胃癌前病变组和正常组cfDNA阳性率比较,差异无统计学意义(P>0.05)。cfDNA、CEA、CA-125和CA19-9作为早期胃癌诊断标志物的敏感度分别为72.58%、65.12%、59.08%和62.38%,特异度分别为83.36%、86.23%、52.26%和55.35%。联合检测cfDNA、CEA、CA-125和CA19-9敏感度为84.46%,特异度为91.25%。cfDNA、CEA、CA-125、CA19-9和联合检测的ROC曲线下面积分别为0.74、0.79、0.51、0.52和0.91。结论在早期胃癌及胃癌前病变患者中cfDNA水平升高,联合检测cfDNA、CEA、CA-125和CA19-9可以提高早期胃癌诊断敏感度、特异度和诊断效能,因此cfDNA可作为早期胃癌潜在的辅助诊断标志物。Objective To explore the clinical value of plasma cell-free DNA(cfDNA)testing in the early diagnosis of gastric cancer and to elucidate the clinical application value of combined testing of cfDNA with serum tumor markers in the early diagnosis of gastric cancer.Methods A total of 180 patients with gastric complaints were included and divided into three age groups:less than 35 years old,35 to 55 years old,and greater than 55 years old.Each age group was further randomly divided into an observation group and a control group.All patients were undergone gastroscopy and pathological testing of biopsy tissue,and tested for CA-125,carcinoembryonic antigen(CEA),and CA19-9.Patients in the observation group were underwgone peripheral blood cfDNA testing.The differences in gastric tissue biopsy pathology among different age groups,differences in cfDNA between different pathological groups,and the sensitivity,specificity,and diagnostic efficacy of cfDNA,CEA,CA-125,and CA19-9 alone and in combination for the early diagnosis of gastric cancer were compared.Results The incidence of gastric precancerous lesions and early gastric cancer gradually increased with increasing age(P<0.05).The level of cfDNA in patients with early gastric cancer was significantly higher than in the precancerous group and the normal group(0.3995 vs.0.1586 ng/μL,0.3995 vs.0.0250 ng/μL,P<0.01).The level of cfDNA in the precancerous group was higher than in the normal group(0.1586 VS.0.0250 ng/μL,P<0.05).The positive rate of cfDNA in early gastric cancer was higher than in the precancerous group and the normal group(75.65%VS.52.52%;75.65%VS.50.68%,P<0.05),while there was no statistically significant difference in the positive rate of cfDNA between the precancerous group and the normal group(P>0.05).The sensitivity of cfDNA,CEA,CA-125,and CA19-9 as markers for the early diagnosis of gastric cancer was 72.58%,65.12%,59.08%,and 62.38%,respectively,and the specificity was 83.36%,86.23%,52.26%,and 55.35%,respectively.The sensitivity of combined testing of cf

关 键 词：早期胃癌 血浆游离DNA 癌胚抗原 糖类抗原125 糖类抗原19-9 

分 类 号：R735.2[医药卫生—肿瘤]