血清肿瘤标志物在结节性肝占位鉴别诊断中的价值

目的探讨检测血清CA125、CA19-9、CEA、CA72-4、AFP对结节性肝占位鉴别诊断的意义。方法 98例发现结节性肝占位的患者,按照肝穿刺后的结果和临床诊断分为肝硬化代偿期组27例;肝硬化失代偿期组26例;肝转移癌组21例;原发性肝癌组24例;17例慢性病毒性肝炎乙型患者作为肝区无占位的对照组。后回顾性分析各组患者的血清CA125、CA19-9、CEA、CA72-4、AFP与结节性肝占位病灶良恶性的关系。结果 CA125在肝硬化失代偿的患者中明显增高,这种增高与肝硬化代偿和慢性肝炎的患者间具有统计学差异(P<0.05)但与原发性肝癌和肝转移癌的患者间无统计学差异(P>0.05);CEA在肝转移癌和原发性肝癌患者中显著高于各组(P<0.05);AFP在原发性肝癌中显著高于各组(P<0.01);CA19-9、CA72-4在各组间均无显著差异(P>0.05)。结论发现肝占位的患者中病灶为恶性的患者普遍出现CEA的增高,原发性肝癌出现AFP与CEA的共同增高,CA125的单纯增高主要出现在肝硬化失代偿的患者中。该研究对于辅助医师决策肝穿刺的时机和肝穿刺前病情的告知具有意义。

The Value of Serum Tumor Markers in the Differential Diagnosis of Focal Liver Lesions

ObjectiveDiscussserumCA125,CA19-9,CEA,CA72-4,AFPvaluefordifferentialdiagnosisinfocalliverlesions.Methods98patientswhofoundlivernodules,accordingtoliverbiopsyandclinicaldiagnosisweredividedintofivegroups：compensatedcirrhosis;decompensatedcirrhosis,primarylivercelcarcinoma;livermetastasiscarcinoma;17 chronic viral hepatitis B patients were enroled as liver no space-occupying lesion control group. Al the patients were retrospectively analyzed serum CA125, CA19-9, CEA, CA72-4andAFP,therelationshipbetweenserumtumormarkersandtuberousliverlesionsbenignandmalignantwerediscussed.ResultsCA125inpatientswithdecompensatedcirrhosissignificantlyhigherthancompensatedcirrhosisandchronicviralhepatitisBpatients,whereasnostatisticaldifferenceswithprimarylivercelcarcinomaandlivermetastasiscarcinomagroups;CEAhigherinlivermetastasisandprimarycarcinomasandnosignificantlydifferencebetweenthattwogroups;AFPinprimarylivercelcarcinomagroupwassignificantlyhigherthanothergroups;CA19-9,CA72-4havenosignificantdifferenceamongeachgroups.ConclusionPatientswithmalignantlivernodulesgeneral yappeartheCEAincrease;primarylivercelcarcinomahadCEAandAFPcommonrise,andCA125increasedonlymainlyappearindecompensatedcirrhosispatients.