胰腺癌临床预警指标和筛查方案研究

目的 探索胰腺癌的预警指标，建立筛查方案。方法 于1996年10月-2000年6月及2002年2月．2004年3月采用以医院为基础病例对照研究，对胰腺癌患者270例，胰腺良性疾病131例，非胰腺癌良性消化道疾病191例，正常人272例，进行各种影像检查（包括B超、CT、ERCP、EUS、DSA）和实验室检查（包括血CA199和CA242、大便K-ras、p53，胰液、十二指肠液K-ras突变检测）进行评估。结果 胰腺癌影像诊断中EUS及ERCP具有最高准确性，K-ras在胰腺癌胰液中突变率为84．4％，十二指肠液中为83．3％，大便中为83．3％，肿瘤标志物CA199和CA242诊断胰腺癌敏感性分别为78．4％和68．3％。结论 大便K-ras、CA199、US的联合试验可使敏感性提高，作为第一步胰腺癌筛选指标，如果可疑则进行CT检查，EUS和ERCP等有创伤性检查作为第三步。

Establishment of Screening Model Based on Study of Clinical Predicting Marker for Pancreatic Cancer

Objective To investigate the clinical predictable marker and screening model of pancreatic cancer. Methods 270 pancreatic cancer cases diagnosed between 1996 - 2000 and 2002 - 2004 were analyzed by using information a case control method collected from, including imaging examination such as US, CT, ERCP, EUS, DAS and laboratory test such as CA199, CA242. The mutation of K - ras in pancreatic juice, intestinal juice and stool were determined to establish a screening model. Results EUS and ERCP were effective imaging tests for detecting abnormal pancreatic masses. The mutation of K - ras was found in pancreatic juice, intestinal juice and stool in 84.4%, 83.3% and 83.3% of pancreatic cancer patients respectively. Tumor marker CA199 was also seen in 78.4% of pancreatic cancer patients. Conclusion K- ras and p53 mutation combined with CA199 were recommended as the primary tests in screening pancreatic cancer patients. EUS and ERCP were consid- erod only for the patients with inconclusive CT studies or normal CT results when symptoms nevertheless suggested the pancreatic cancer.