不明原因下肢深静脉血栓形成患者肿瘤标志物的临床意义

目的分析65例不明原因下肢深静脉血栓形成患者血清肿瘤标志物癌胚抗原(carcinoembryonic antigen,CEA)、甲胎蛋白(alpha fetal protein,AFP)、肿瘤抗原(carcinomic antigen,CA)125、CA199、CA242及CA724的表达情况并探讨其诊断价值。方法回顾性分析赤峰市医院2014年2月至2017年11月收治的65例不明原因下肢深静脉血栓患者形成的临床资料,根据病理检查结果分为肿瘤组(23例)和非肿瘤组(42例),检测CEA、AFP、CA125、CA199、CA242及CA724分子阳性表达情况并检验其临床诊断效能。结果肿瘤组中,CEA、AFP、CA125、CA199、CA242和CA724阳性率分别为73.91%、60.87%、78.26%、47.83%、43.48%和13.04%;非肿瘤组中,CEA、AFP、CA125、CA199、CA242和CA724阳性率分别为11.9%、7.14%、14.29%、11.90%、11.90%和19.05%,除CA724外差异均有统计学意义。受试者工作曲线显示,CEA、AFP、CA125、CA199、CA242和CA724的AUC分别为0.716、0.492、0.430、0.732、0.554和0.514;其中AFP和CA125的诊断效能较差,曲线下面积值低于0.5,CEA、CA199、CA242和CA724效能高,曲线下面积值大于0.5。CEA (OR=20.967)、AFP(OR=20.222)、CA125(OR=21.600)、CA199 (OR=6.783)、CA242 (OR=5.692)是下肢深静脉血栓形成肿瘤发生的危险因素,CA724可能是肿瘤发生的保护因素(OR=0.638)。结论 CEA、CA199、CA242和CA724表现出较好的诊断效能,对下肢深静脉血栓的病因明确具有重要意义,但仍需大样本临床研究证实。     

联合检测AFP、CEA、CA125、CA199对原发性肝癌的诊断价值

目的探讨联合检测AFP、CEA、CA125、CA199对原发性肝癌(肝癌)的诊断价值。方法选取2014-01—2017-08间西平县人民医院收治的40例肝癌患者为肝癌组,将同期在该院行体检的40例健康人群为对照组。均于清晨空腹采取静脉血3 m L,采用电化学发光法检测血清AFP、CEA、CA125、CA199的浓度。回顾性分析受检者的临床资料。结果肝癌组患者血清中AFP、CEA、CA125、CA199的浓度均显著高于对照组,差异有统计学意义(P0.05)。其中,AFP对肝细胞癌的灵敏度高,CEA、CA125、CA199对胆管细胞癌的灵敏度高。结论联合检测AFP、CEA、CA125、CA199,可有效提高肝癌的的早期诊断率。     

多项肿瘤标志物联合检测对肝癌早期诊断的作用

目的 探讨多项肿瘤标志物联合检测在原发性肝癌中的诊断价值及建立判别方程.方法 采用蛋白芯片技术,检测2003年11月至2006年4月大坪医院收治的98例原发性肝癌患者(肝癌组)、67例良性肝病患者(肝病组)、46例健康体检者(对照组)血清中的12项肿瘤标志物,并在肝癌组与肝病组患者之间建立判别方程.采用方差分析和X2检验对检测结果进行分析.结果 肝癌组中87例患者肿瘤标志物呈阳性表达(89%),肝病组中有13例呈阳性表达(19%),对照组中有2例呈阳性表达(4%).3组中的AFP、CEA、铁蛋白、CA19-9和CA125检测结果比较,差异有统计学意义(F=59.530,40.472,31.708,75.897,153.066,P<0.05).联合检测这5项指标,肝癌临床诊断符合率提高为89%,明显高于单项AFP检测的64%(X2=16.362,P<0.05).所建判别方程的判断准确率为90%.结论 多项肿瘤标志物联合检测优于单独AFP检测,可用于对肝癌高危人群的筛查及原发性肝癌的早期诊断.     

大肠癌多种肿瘤标志物蛋白芯片联合检测及其在诊断中的意义

目的研究大肠癌患者血清中多种肿瘤蛋白标志物的改变情况及联合检测在诊断中的价值。方法采用C12多种肿瘤标志物蛋白芯片检测系统测定139例大肠癌患者和63例大肠良性病变患者血清中12种肿瘤标志物(CA199,NSE,CEA,CA242,CA125,CA153,AFP,ferritin,f PSA,PSA,βHCG及HGH)的水平,分析其差异,并评估该方法的应用价值。结果在单项指标中,大肠癌患者血清CEA、CA199、CA242和CA125阳性率分别为48.20%、32.37%、28.06%和28.06%,均显著高于良性病变组(P<0.01)。采用多项指标判定标准的结果,联合检测既可以提高诊断敏感性,也可以获得较好的特异性。结论多种肿瘤标志物蛋白芯片联合检测对大肠癌诊断具有辅助价值,其中CEA、CA199、CA242和CA125的诊断价值较高。     

TSGF在大肠癌诊断及术后治疗效果观察中的应用价值

探讨血清肿瘤特异性生长因子(TSGF)在大肠癌诊断及治疗效果观察中的价值。选取广东省中医院大学城医院收治的确诊大肠癌患者40例作为观察组,40例炎性肠病患者作为对照组,体检中心40例经肠镜检查健康者作为健康组,分别检测3组研究对象的血清TSGF、癌胚抗原(CEA)、癌抗原199(CA199)的水平,比较观察组术前及术后4周患者的血清TSGF、CEA、CA199水平变化,对TSGF、CEA、CA199鉴别诊断大肠癌的效能进行评价。观察组术前血清TSGF、CEA、CA199水平显著高于对照组、健康组(P0.05),对照组和健康组的血清TSGF、CEA、CA199水平差异无统计学意义(P0.05)。观察组术后血清CEA、CA199水平显著高于对照组、健康组(P0.05),TSGF水平与对照组、健康组比较差异无统计学意义(P0.05)。观察组术后血清TSGF、CEA、CA199水平显著低于术前(P0.05)。TSGF+CEA+CA199联合诊断大肠癌的灵敏度为87.5%,特异度为85%,一致性Kappa值为0.725,均高于3种肿瘤标志物单独应用的诊断价值。大肠癌血清TSGF在手术治疗前后变化较为敏感,可以根据其变化对治疗效果进行判定;血清TSGF对大肠癌术前诊断具有一定的价值,结合CEA、CA199肿瘤标志物能够显著提高术前诊断效能。     

联合应用肿瘤标记物在胰腺癌诊断中的意义

目的 探讨肿瘤标记物糖链抗原199(CA 199)、肿瘤抗原242(CA 242)与癌胚抗原(CEA)联合检测对胰腺癌诊断及预后判断的意义.方法 用化学发光技术分别检测胰腺癌50例、胰腺良性疾病42例和健康体检者60例的血清CA 199、CA 242与CEA表达.结果 胰腺癌组CA199、CA 242与CEA等3种标志物血清值分别为(226.26±42.06)、(68.82±7.63)与(9.63±5.84)μg/L,均明显高于其他组(P<0.05);胰腺癌组CA 199、CA 242与CEA阳性率分别为82.61%、76.09%与60.87%,与其他两组比较.差异均有统计学意义(P<0.05);CA 199、CA 242与CEA等3项联检准确性达97.83%.CA 199与胰腺癌分期呈正相关,与患者生存期呈负相关.结论 肿瘤标志物联合检测可明显提高胰腺癌早期确诊率,CA 199对判断预后有一定参考价值.     

胃蛋白酶原与肿瘤标志物联合检测在胃癌诊断中的临床价值

探讨胃蛋白酶原和4种肿瘤标志物CEA、CA50、CA199、CA242联合检测对胃癌诊断的临床意义。102例胃癌患者(胃癌组)、87例胃部良性病变患者(胃良性病变组)和71例健康体检患者(对照组)。应用全自动电化学发光免疫分析仪,测定不同临床分期患者血清肿瘤标志物含量水平,分析检测结果。结果显示,胃癌组血清胃蛋白酶原Ⅰ和CEA、CA50、CA199、CA242水平高于良性病变组和对照组患者(P0.05),良性病变组上述指标高于对照组(P0.05);胃癌Ⅲ、Ⅳ期组患者血清胃蛋白酶原Ⅰ和CEA、CA50、CA199、CA242含量明显高于胃癌Ⅰ、Ⅱ期组;指标联合检测的阳性率高于单项检测阳性率(P0.05)。结果表明,胃癌患者血清胃蛋白酶原Ⅰ和CEA、CA50、CA199、CA242含量较高,转移后上述指标血清含量增加,联合检测比单一检测更具诊断价值。     

肿瘤标志物联合检测在胰腺癌诊断和疗效评价中的作用

目的：探讨CA199、CA242、CA125、CEA和OPN联合检测对胰腺癌诊断和疗效评价的临床价值。方法检测41胰腺癌患者术前及术后1个月和40例健康体检者外周血清中肿瘤标志物CA199、CA242、CA125、CEA和OPN的水平,比较胰腺癌组术前和术后的变化。并计算肿瘤标志物诊断胰腺癌的敏感性、特异性及准确性。结果胰腺癌组各肿瘤标志物测定值及阳性率明显高于正常对照组,术前测定值明显高于术后,差异有统计学意义,P均〈0．05。标志物联合检测的敏感性和诊断准确性均比单项检测高,其中单项以CA199敏感性最高。结论CA199、CA242、CA125、CEA和OPN联合检测对胰腺癌的诊断、疗效观察及复发预测是较理想的指标,具有重要的临床意义。     

原发性肝癌的血清肿瘤标记物研究

目的 探讨血清肿瘤标志物鉴别诊断肝内胆管癌(ICC)和肝细胞癌(HCC )的临床应用价值.方法 收集我科从2003年到2010年,68例HCC和ICC病人的术前血清,测定AFP、CA242、CA199、CEA和CA50血清水平.结果 血清AFP,CA199和CA242在两组病人间差异有统计学意义(P<0.05).联合检...     

胆管结石患者血清及胆汁中肿瘤标志物的测定

目的:研究胆管结石患者血清及胆汁中肿瘤标志物的水平,了解肝功能生化指标与肿瘤标志物检测的关系。方法:通过ERCP抽取胆道结石患者的胆汁,采用放射免疫测定法测定44例胆道结石患者血清及胆汁中癌胚抗原(CEA)和糖链抗原(CA199)的含量,确定胆道结石患者血清及胆汁中2种肿瘤指标的水平;结合患者肝功能检查结果,分析与肿瘤标志物检测可能相关的肝功能指标。结果:胆汁及血清肿瘤指标在胆道结石患者中均升高,胆汁CEA及CA199平均水平均明显高于血清CEA及CA199的平均水平(P<0.05);血清CA199在梗阻性黄疸患者中升高更明显,而血清CEA的异常比例较CA199异常的更少(P<0.05);血清及胆汁CEA,CA199水平与肝功能各项指标无明显关系。结论:测定胆汁CEA及CA199的临床意义有限;血清CA199在存在胆道结石等梗阻因素时,其升高亦无临床意义。     

Identification of a novel prostate cancer-associated tumor antigen

BACKGROUND: The identification of antigens that distinguish cancer cells from normal cells is of major importance for the definition of therapeutic targets in human malignancies. Using sera from cancer patients, we have previously reported on the identification of immunologically recognized proteins that belong to the family of cancer testis antigens (CTAs). METHODS: A normal testicular cDNA library was screened with pooled allogeneic sera from patients with prostate cancer using a modified SEREX approach. Subsequently we have identified and characterized a novel antigen, T21, with an expression pattern similar to that of CTAs. mRNA expression of T21 was determined using a panel of whole tissues and prostate cell lines using Q-RT-PCR. For laser microdissection, fresh prostate cancer and benign tissue was obtained using our novel validated harvesting technique. Protein expression and cellular localization of T21 were assessed in prostate cell lines using Western blotting, confocal microscopy and flow cytometry. RESULTS: T21 showed tissue-restricted mRNA expression in gastric, kidney and prostate cancers, and in normal testis and prostate tissues. Following laser microdissection, T21 was significantly over-expressed in malignant compared to benign prostatic epithelium. We have demonstrated expression of T21 at the protein level and confocal microscopy on PC3 cells probed with a T21-monospecific antibody revealed cytoplasmic localization of T21 protein. CONCLUSIONS: The highly restricted expression pattern of T21 makes it an attractive vaccine target for prostate cancer. Several CTAs reportedly induce cytotoxic T-lymphocyte responses, therefore it is reasonable to assume that T21 will be a valuable target for cancer immunotherapy.     

Prostate cancer biomarkers: An update

Many aspects of prostate cancer diagnosis and treatment could be greatly advanced with new, effective biomarkers. Prostate-specific antigen (PSA) has multiple weaknesses as a biomarker, such as not distinguishing well between cancer and benign prostatic hyperplasia or between indolent and aggressive cancers, thus leading to overtreatment, especially unnecessary biopsies. PSA also often fails to indicate accurately which patients are responding to a given treatment. Yet PSA is the only prostate cancer biomarker routinely used by urologists. Here, we provide updated information on the most relevant of the other biomarkers currently in use or in development for prostate cancer.Recent research shows improvement over using PSA alone by comparing total PSA (tPSA) or free PSA (fPSA) with new, related markers, such as prostate cancer antigen (PCA) 3, the individual molecular forms of PSA (proPSA, benign PSA, and intact PSA), and kallikreins other than PSA. Promising results have also been seen with the use of the fusion gene TMPRSS2:ERG and with various forms of the urokinase plasminogen activation receptor. Initially, there were high hopes for early PCA, but those data were not reproducible and thus research on early PCA has been abandoned.Much work remains to be done before any of these biomarkers are fully validated and accepted. Currently, the only markers discussed in this paper with Food and Drug Administration-approved tests are PCA 3 and an isoform of proPSA, [-2]proPSA. Assays are in development for most of the other biomarkers described in this paper. While the biomarker validation process can be long and filled with obstacles, the rewards will be great—in terms of both patient care and costs to the health care system.     

Possibilities for an extended classification of bladder cancer

Summary Patients with bladder cancer were evaluated for T-class, histo-pathological grade and U-CEA (urinary carcinoembryonic antigen) before treatment and the cytological picture 4 months after treatment. Previous work has shown that these variables are not significantly intercorrelated. Scores were computed, consisting of the sums of these (dichotomized) variables. In a statistical analysis with the life-table technique, the scored variables have been logrank tested for a prognostic trend. In 155 patients, p for symptom-free survival between subgroups with low and high scores was 0.0019 and for relative survival 0.0005. This implies that a combination of variables may have predictive value in bladder cancer.     

大肠癌患者门静脉及外周血癌胚抗原与组织病理变化的关系

为了研究门静脉及外周血癌胚抗原（ＣＥＡ）与组织病理变化的关系，我们检测了６２例大肠癌患者门脉及外周血的ＣＥＡ。结果显示，门静脉血ＣＥＡ显著高于外周血；门脉及外周血ＣＥＡ的升高与静脉侵犯及Ｄｕｋｅｓ分级有强相关关系，门脉血ＣＥＡ的升高还与肿瘤大小、分化程度、淋巴结转移有关。ＣＥＡ值随静脉侵犯程度的增加而升高。手术刺激有静脉侵犯的癌肿后，ＣＥＡ显著升高，没有静脉侵犯者则无变化。结果表明，ＣＥＡ主要是通过门静脉进入外周血。ＣＥＡ的升高表明癌肿的静脉侵犯业已发生，预后不良。     

8点及12点前列腺穿刺活检诊断前列腺癌的价值比较研究

目的比较8点及12点前列腺穿刺活检诊断前列腺癌的价值,分析前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)及前列腺体积(PV)对前列腺癌检出率(PCDR)的影响。方法回顾性分析260例因PSA异常增高而接受首次直肠超声引导下前列腺穿刺活检的患者相关资料,其中132例患者接受8点穿刺,128例患者接受12点穿刺。结果依据PSA、PV、PSA与PV及PSAD,患者被进一步分组。8点及12点的总的PCDR没有显著的差异,在PV≥45mL、PSA≥10ng/mL且PV≥45mL及0.15ng/(mL·cm3)≤PSAD≤0.25ng/(mL·cm3)组中,12点的PCDR明显高于8点。结论 8点及12点前列腺穿刺总的PCDR没有显著区别(P0.05),但在PV较大同时PSA较高或者PSAD处于中等大小时(0.15~0.25)ng/(mL·cm3),12点的PCDR明显高于8点(P均0.05)。     

Usefulness of prostate-specific antigen velocity in screening for prostate cancer

BACKGROUND: The cut-off value of prostate-specific antigen velocity (PSAV) was investigated in relation to the initial prostate-specific antigen (PSA) value in subjects with initial values of 1.0-4.0 ng/mL, and the usefulness and limitations of PSAV as a screening test for prostate cancer were examined. METHODS: In this study, 4883 men who underwent mass screening for prostate cancer two or more times between 1987 and 1998 and had initial PSA levels of 1.0-4.0 ng/mL were investigated. The subjects ranged in age from 42 to 96 years (mean: 68.0 +/- 6.6 years). The cut-off value of PSAV was set at 0.1-1.5 ng/mL per year, and the sensitivity, specificity, efficiency and positive predictive value (PPV) of PSAV for detecting prostate cancer were determined according to the initial PSA value. A similar examination of the average PSAV was carried out in 2888 subjects with three or more visits for mass screening for prostate cancer. RESULTS: The diagnostic efficiency of PSAV was optimal with cut-off values of 0.3 and 0.75 ng/mL per year in those subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 1.8% in subjects with initial PSA levels of 1.0-1.9 ng/mL. When the cutoff value of PSAV was set at 1.2 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV increased to 7.3% and the sensitivity was 40%. The diagnostic efficiency of the average PSAV was optimal at the cut-off values of 0.2 and 0.4 ng/mL per year in subjects with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively, but the PPV was low at 2.2% in the subjects with initial PSA values of 1.0-1.9 ng/mL. When the cut-off value of PSAV was set at 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 ng/mL, the PPV was 9.8% and the sensitivity was 46%. CONCLUSION: It is possible to improve the diagnostic accuracy of prostate cancer screening using the cut-off value of PSAV and average PSAV in subjects with initial PSA levels of 1.0-4.0 ng/mL. The cut-off values of PSAV should be set at 1.2 and 0.75 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively. The cut-off values of the average PSAV should be set at 0.75 and 0.4 ng/mL per year in individuals with initial PSA levels of 1.0-1.9 and 2.0-4.0 ng/mL, respectively.     

血清前列腺特异抗原测定的临床意义

以12例前列腺癌、102例前列腺良性增生(BPH)、16例直肠指检(DRE)异常、5例前列腺炎及30例正常男性为对象,用酶免法测定血清前列腺特异抗原(Prostate specific antigen,PSA)浓度,用放免法测定其中37例。前列腺癌的PSA浓度明显高于BPH(P<0.01),PSA对前列腺癌诊断的敏感性为91.7％。DRE异常者大于BPH(P<0.05),低于前列腺癌(P<0.01)。BPH高于正常对照(P<0.01)。前列腺切除术后一日的PSA高于术前(P<0.01),术后6～8日同术前无显著性差异(P>0.05)。70岁以上高于70岁以下(P<0.05)。PSA>10ng/ml时酶免检测值低于放免法(0.010.05)。单纯PSA升高并不能说明任何特异性病理过程,前列腺癌的诊断,应结合PSA系列测定值及DRE和经直肠B超(TRUS)来综合分析。     

前列腺癌组织中PSCA在蛋白质和mRNA水平表达相关性分析及其意义

目的:探讨人前列腺癌组织中前列腺干细胞抗原(PSCA)蛋白和mRNA的表达状况及其相关性.方法:采用免疫组化和原位杂交方法同步检测48例前列腺癌组织中PSCA蛋白和mRNA的表达,并进一步比较其表达水平之间的相关性.结果:免疫组化和原位杂交检测显示:42例(87.5%)的PSCA蛋白阳染区域所见与其mRNA阳染区域相同,其中的37例的蛋白和mRNA表达水平(评分值)均一致,其余11例的PSCA蛋白表达水平与其mRNA表达水平比较,均有不同程度的降低.结论:PSCA蛋白和mRNA在人前列腺癌组织中的表达水平具有很高的一致性,PSCA蛋白表达与PSCA基因的转录密切相关.     

胰腺囊腺瘤和囊腺癌165例临床诊治分析

目的探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治方法。方法对我院2002年1月至2012年9月收治的165例胰腺囊性肿瘤患者的临床及病理资料进行回顾性分析。结果胰腺囊性肿瘤好发于中年女性,临床表现缺乏特异性,其中74例患者因体检时行B超或CT等影像学检查发现胰腺囊性占位来院就诊,影像学检查虽然是发现病灶的主要检查方法,但不能确定疾病病理类型。肿瘤位于胰腺头部40例,胰腺颈部34例,胰腺体尾部91例;行不同术式的肿瘤切除160例,剖腹探查、肿瘤活检3例,行胃空肠转流术2例。患者术前免疫学指标糖链抗原125(CA125)单项指标检测的特异度显著高于糖链抗原19-9(CA19-9)单项指标检测以及联合检测的特异度(P0.05)。结论在鉴别诊治胰腺囊腺瘤和囊腺癌患者中,结合患者术前影像学检查结果和免疫学肿瘤指标检测结果,有助于提高术前预判的准确性。由于CA19-9在良性疾病中也有升高现象,所以CA125检测有助于减少这种假阳性的结果。手术切除是胰腺囊腺瘤和囊腺癌的主要治疗手段。     

正常血清PSA进展期前列腺癌1例报告并文献复习

目的:探讨正常血清PSA进展期前列腺癌患者的诊断及治疗方法,提高前列腺癌的诊疗水平。方法:回顾性分析2010年收治的1例正常血清PSA进展期前列腺癌患者临床资料,结合相关文献,讨论正常血清PSA进展期前列腺癌的诊断及治疗方法。结果:患者血清PSA水平一直处于正常水平,经病理学检查证实为前列腺癌,临床分期为T4N0M0,行前列腺去势术+抗雄激素治疗,现已无进展生存15个月。结论:正常血清PSA进展期前列腺癌多系特殊病理类型的前列腺癌,预后相对较差。在进行PSA筛查时,需综合考虑f/tPSA比值;术后随诊时需定期进行影像学检查,以了解有无疾病进展;治疗上除采取内分泌治疗外,必要时宜早期采用放疗及化疗。