血清肿瘤标志物CEA、CA19—9及CA72-4在胃癌中的应用价值研究

目的探讨CEA、CA19-9以及CA72-4在胃癌诊断、病理特征及疗效评价中的参考价值。方法选取胃癌初诊患者为胃癌组，同期收治的胃良性病变患者和门诊体检者为对照组，分别测定2组病例血清CEA、CA19—9及CA72-4的浓度，并分析胃癌患者的相关临床资料，最后采用判别分析建立胃癌诊断判别式以及术前预测胃癌是否伴有区域淋巴结转移的判别式。结果胃癌患者3种标志物的血清浓度均高于对照组（P〈0．01），表达阳性率也高于对照组（P〈0．05）。联合检测可明显提高检测灵敏度。Ⅲ-Ⅳ期胃癌标志物的阳性率高于Ⅰ-Ⅱ期（P〈0．01），有区域淋巴结转移的患者肿瘤标志物的阳性率高于无区域淋巴结转移的患者（P〈0．05）。术后好转的患者3种标志物的血清浓度均低于术前（P〈0．01）。所建立的两个判别函数的灵敏度、特异性、总正确率分别为27．9％、97．5％、64．2％和32．3％、95．9％、60．4％。结论CEA、CA19-9及CA72-4是胃癌诊断的良好辅助手段，也是预测胃癌分期及区域淋巴结转移的因子，并且是胃癌疗效评价的参考因子之一，所建立的判别函数具有良好的判别效能。

Application value research of serum tumor markers CEA,CA19-9 and CA72-4 in gastric cancer

Objective To investigate the reference value on diagnosis, pathological characteristics and prognosis of serum tumor markers CEA, CA19-9 and CA72-4 in gastric cancer. Methods Patients with the first diagnosis of gastric cancer and gastric benign disease patients or outpatients during the same period were selected. Detecting serum concentrations of CEA, CA19-9 and CA72-4 of the two groups respectively and analyzing the related clinical data of gastric cancer patients. Finally, discriminant analysis method was adopted to establish two discriminant function of diagnosis of gastric cancer and regional lymph node metastasis. Results The serum concentrations of gastric cancer patients were higher than control group （P 〈 0. 001 ） , and the positive rate were also higher than control group （ P 〈 0.05 ）. Joint detection could improve the detection sensitivity obviously. The positive rate of tumor markers of m - Iv stage gastric cancer was higher than I - II stage（P 〈0.01 ）. The positive rate of regional lymph node metastasis patients was higher than patients with no regional lymph node metastasis（ P 〈 0.05 ）. Concentrations of tumor markers were lower than pre-operation in patients with im- provement of the disease （ P 〈 0.01 ）. The sensitivity, specificity and accuracy of the two discriminant function were 27.9% ,97.5% ,64.2% and 32.3% ,95.9% ,60.4% respectively. Conclusion The detection of the expression levels of CEA, CA19-9 and CA72-4 was a good assistant method for the diagnosis of gastric cancer. All of them can be used as predicting factors of gastric cancer staging and regional lymph node metastasis. Besides, they can be used as reference fac- tors in evaluating curative effect of gastric cancer. The two discriminant functions had good discriminant efficiency.