肿瘤标志物CEA和CA19-9在消化系统恶性肿瘤中的诊断效率评价

目的以病理诊断为金标准，运用流行病学理论较全面分析与评价血清CEA和CA19-9对消化系统肿瘤的诊断效率和临床意义。方法应用电化学发光免疫分析法测定消化系统272例恶性肿瘤及167例良性疾病患者血清CEA和CA19—9水平，对其敏感性、特异性、准确性、阳性预测值、阳性似然比和优势比进行比较分析。结果单检CEA和CA19-9诊断消化系统恶性肿瘤的敏感性分别为34.2％和45.2％，联检49．3％；特异性80.8％和60．5％，联检59.3％；准确性由单检的51．9％（CEA）和51．0％（CA19-9）提高至53．1％（CEA和CA19—9）；阳性预测值74.4％和65．1％；阳性似然比1.8和1.1;优势比2.19和1.260结论消化系常见肿瘤中，CEA诊断胰腺癌的敏感性最高，胆囊胆管癌和结直肠癌次之；特异性和阳性似然比以胆囊胆管癌最高。CA19-9诊断胆囊胆管癌敏感性最高，胰腺癌次之；特异性、阳性预测值、阳性似然比均以胰腺癌最高，并且诊断胰腺癌的优势比大于10。除胃癌及食道癌外，CA19．9敏感性高于CEA，联合检测CEA和CA19-9可提高诊断敏感性和准确性，但就阳性预测值和阳性似然比而言，单检CEA和CA19．9对某些器官肿瘤的诊断意义更大。

The diagnostic value of CEA and CA19-9 in malignancy diseases of digestive system

Objective To apply the clinical epidemic principles to analyze and evaluate the diagnostic value and clinical significance of such tumor markers as CEA and CA19-9 in tumors of digestive system,all defined by pathology.Methods The serum concentrations of these tumor markers in 272 tumors of digestive system and 167 benign diseases by means of electrochemiluminescence immunoassay(ECLIA) were detected and their sensitivity,specificity,accuracy,positive predictive value(PPV),positive likelihood ratio(LR+) and odds ratio(OR)were compared.Results The sensitivity of CEA and CA19-9 to diagnose tumors of digestive system was 34.2% and 45.2% respectively and 49.3% in combination,while the specificity of them was 80.8% and 60.5%,respectively and then 59.3% in combination.The accuracy increased from 51.9%(CEA) and 51.0%(CA19-9) to 53.1%(CEA and CA19-9).Also,PPVs were 74.4% and 65.1% for CEA and CA19-9 to diagnose the tumors.LR+s were 1.8 and 1.1.ORs were 2.19 and 1.26.Conclusion The sensitivity of CEA to diagnose pancreatic carcinoma was highest and a bit higher for carcinoma of gallbladder and bile duct as well as colorectal carcinoma;For carcinoma of gallbladder and bile duct,the specificity and LR+ were both highest.On the other hand,the sensitivity of CA19-9 to diagnose carcinoma of gallbladder and bile duct was much higher than that of any other tumor,followed by pancreatic carcinoma,while the specificity,PPV and LR+ were highest of pancreatic carcinoma.It had to be noted that OR of pancreatic carcinoma was more than 10.Except for stomach and esophagus tumors,the sensitivity of CA19-9 was higher than that of CEA.It indeed improved the sensitivity and accuracy in diagnosing tumors of digestive system to measure CEA and CA19-9 in combination,however,with regard to PPV and LR+,it seemed more meaningful to test CEA and CA19-9 respectively to diagnose some specific tumors.