糖类抗原125、糖类抗原15-3、糖类抗原19-9和人附睾蛋白4单独及联合检测对卵巢癌的诊断价值

目的研究糖类抗原125(CA125)、CA15-3、CA19-9和人附睾蛋白4(HE4)单独及联合检测对卵巢癌的诊断价值,探讨最优的联合诊断方案。方法选取90例卵巢癌患者、90例良性卵巢疾病患者及90同期健康体检者,分别作为肿瘤组、良性组和健康组。比较3组受试者血清CA125、CA15-3、CA19-9和HE4水平及阳性率,比较上述四种肿瘤标志物单独及联合检测对卵巢癌的诊断灵敏度、特异度及准确度。结果肿瘤组患者CA125、CA15-3、CA19-9和HE4水平及阳性率均高于良性组患者和健康组受试者,良性组患者血清CA125、CA15-3和CA19-9水平均高于健康组受试者,良性组患者血清CA125、CA15-3、CA19-9和HE4阳性率均高于健康组受试者,差异均有统计学意义(P﹤0.05)。CA125+CA15-3+HE4、CA125+CA15-3+CA19-9+HE4诊断卵巢癌灵敏度最高,均为91.11%。HE4单独诊断卵巢癌的特异度最高,为94.44%。CA125+CA15-3+HE4诊断卵巢癌的准确度最高,为85.93%。结论CA125+CA15-3+HE4三项联合检测可提高卵巢癌诊断效率,对临床诊断卵巢癌有参考价值。     

肿瘤标志物CEA、CA153、SCC、Cy211联合检测对胸腔积液鉴别诊断的意义

目的　探讨肿瘤标志物联合检测在良、恶性胸腔积液鉴别诊断中的临床意义。方法　采集有胸腔积液患者的血清及胸水样本各 79例 ,其中恶性胸腔积液患者 35例 ,良性胸腔积液患者 4 4例 ,用免疫放射法检测其血清及胸水CEA、CA15 3、SCC和CY2 11的含量。结果　恶性胸水组血清CEA、CA15 3、SCC和CY2 11的阳性率分别为 5 8.82 %、70 .5 9%、9.0 9%和 5 4 .2 0 % ,胸水CEA、CA15 3、SCC和CY2 11的阳性率分别为 75 .76 %、70 .6 7%、2 5 .93%和 96 .6 7% ,其中 ,肿瘤标志物CEA、CA15 3和CY2 11血清及胸水的阳性率明显高于良性胸腔积液组 (P <0 .0 2 ) ;两组含量的检测亦得出相似的结果。联合检测血清CA15 3 CY2 11,其诊断恶性胸腔积液的敏感度为 94 .2 8% ,特异度为 76 .93%。结论　肿瘤标志物CEA、CA15 3和CY2 11的联合检测 ,对胸腔积液的鉴别诊断有较好的临床价值 ,联合方式以CA15 3 CY2 11为佳。     

CEA、CA199和细胞形态学联合检测对281例良、恶性胸腔积液鉴别诊断的临床意义

[目的]探讨肿瘤标志物CEA、CA199、细胞形态学联合检测在鉴别良、恶性胸腔积液中的临床意义。[方法]收集281例胸腔积液患者,其中恶性组149例,良性组132例。采用化学发光免疫法测定患者血清及胸腔积液中CEA和CA199水平。胸腔积液经离心、推片和瑞氏染色后进行细胞形态学检查,以鉴别胸腔积液的良、恶性,并评价CEA、CA199、细胞形态学联合检测在鉴别良、恶性胸腔积液诊断中的敏感度及特异度。[结果]恶性组胸腔积液CEA、CA199水平及阳性率均高于良性组（P<0.05）;恶性组血清CEA、CA199的检测水平均高于良性组（P<0.05)。胸腔积液CEA+CA199肿瘤标志物联合检测的敏感度、特异度及ROC曲线下面积分别为73.82%、69.7%和0.720,而胸腔积液CEA+CA199联合细胞形态学检查的敏感度、特异度及ROC曲线下面积更优,分别为85.23%、69.7%和0.777。[结论]联合测定胸腔积液中CA199、CEA水平和细胞形态学分析能提高良、恶性胸腔积液的鉴别诊断价值。     

NSE、CYFRA21-1、CA125、CA19-9、CEA联合检测在抑郁症伴肺癌诊断中的价值

目的 探讨NSE、CYFRA21-1、CA125、CA19-9和CEA在抑郁症伴肺癌患者诊断中的价值.方法 选择2010年12月至2015年12月收治的抑郁症伴肺癌的患者46例纳入A组,收集同期单纯肺癌患者50例纳入B组和健康体检者50例纳入C组.检测入选者血清NSE、CYFRA21-1、CA125、CA19-9和CEA浓度.采用17项汉密顿抑郁量表(HAMD)对抑郁症患者进行评定.结果 A组和B组患者血清NSE、CYFRA21-1、CA125、CA19-9和CEA浓度均显著高于对照组,差异有统计学意义(P＜0.05).A组与B组比较,血清NSE、CYFRA21-1、CA125、CA19-9和CEA浓度无统计学差异(P＞0.05).小细胞肺癌患者中血清NSE的浓度显著升高(P＜0.05);鳞癌患者中血清CYFRA21-1浓度显著升高(P＜0.05);腺癌患者中血清CA125浓度显著升高(P＜0.05).5种肿瘤标志物诊断抑郁症伴肺癌敏感度由高到低依次为NSE (0.652)、CA125 (0.598)、CYFRA21-1(0.549)、CEA (0.530)和CA19-9(0.437);特异度由高到低依次为CY-FRA21-1 (0.838)、NSE (0.820)、CA19-9 (0.819)、CA125 (0.718)和CEA(0.659).联合检测的曲线下面积(AUC)为0.826,显著高于任何一种单一标志物(P＜0.05).结论 抑郁症伴肺癌患者血清NSE的浓度与抑郁症的严重程度正相关,联合NSE、CYFRA21-1、CA125、CA19-9和CEA能显著提高抑郁症伴肺癌患者的检出率.     

肿瘤标志物联合检测在良恶性胸腔积液鉴别诊断中的价值

 目的　探讨胸腔积液4种肿瘤标志物联合检测在良恶性胸腔积液鉴别诊断中的价值。方法　采用电化学发光免疫法检测126例胸腔积液患者（其中恶性组52例,良性组74例）癌胚抗原（CEA）、糖类抗原125（CA125）、糖类抗原15-3（CA15-3）和细胞角蛋白片段19（CYFRA21-1）水平, 并计算上述指标单独和与CEA联合检测在诊断中的敏感度、特异度、准确度和约登指数（YI）。结果　恶性组4种肿瘤标志物水平均明显高于良性组（P＜0.01）。单项检测各种肿瘤标志物的敏感度以CA125最高（90.4 %）,特异度以CYFRA21-1最高（79.7 %）,诊断准确度以CEA和CYFRA21-1最高（71.4 %）,YI以CEA最高（0.41）。联合检测较单项检测敏感度、准确度和YI明显提高,其中CEA、CYFRA21-1和CA15-3三项联合效果最好,敏感度为92.3 %,特异度为78.4 %,准确度为84.1 %,YI值最高为0.71。四项联合敏感度为94.2 %,特异度为75.7 %,准确度为83.3 %,YI值为0.70,与三项联合结果相比差异无统计学意义（P＞0.05）。结论　单项检测的诊断价值有限,CEA、CYFRA21-1和CA15-3三项联合效果最好、最经济,可指导患者恰当选择进一步的侵入性检查手段。     

肿瘤分子标志联合检测对胸腔积液鉴别诊断价值分析

目的:探讨癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角蛋白片段19(CYFRA21-1)和神经元特异性烯醇化酶(NSE)联合检测在良恶性胸腔积液鉴别诊断中的价值。方法:电化学发光法检测56例恶性胸腔积液患者和78例良性胸腔积液患者的CEA、CA125、CYFRA21-1和NSE的浓度和阳性表达率,比较其差异。结果:恶性组与良性组CEA(t=5.102)、CA125(t=4.294)、CYFRA21-1(t=3.602)和NSE(t=2.142)浓度进行比较,差异均有统计学意义,P值均<0.05。恶性组与良性组CEA(χ2=69.07)、CA125(χ2=67.34)、CYFRA21-1(χ2=73.99)和NSE(χ2=78.59)阳性率进行比较,差异有统计学意义,P值均<0.01。单项检测各种肿瘤分子标志诊断良恶性胸腔积液的敏感度和特异性以CEA最高,分别为33.93%(19/56)和97.44%(76/78)。联合检测较单项检测敏感度明显增高。2项检测以CEA和CYFRA21-1敏感性和特异性最高,分别为44.64%(25/56)和96.15%(75/78)。3项检测以CEA、CYFRA21-1和NSE联合检测敏感性和特异性最高,分别为51.79%(29/56)和91.03%(71/78)。CEA+CA125+CYFRA21-1+NSE 4项联合检测效果最佳,其敏感性高达53.57%(30/56),特异度达85.90%(67/78)。结论:胸腔积液CEA、CA125、CYFRA21-1和NSE联合检测在良恶性胸腔积液鉴别诊断中有重要意义。     

血清碱性磷酸酶、癌胚抗原、糖类抗原19-9联合检测对胃癌骨转移的诊断价值

目的探讨碱性磷酸酶(ALP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)单独与联合检测对胃癌骨转移的诊断价值,为胃癌骨转移的早期诊断提供依据。方法收集522例胃癌患者的临床资料及血清标志物(ALP、CEA、CA19-9)检测结果,根据有无骨转移将入组患者分为骨转移组(n=91)和无骨转移组(n=431)。参照Soloway分级标准将骨转移分为3级,进一步分析ALP、CEA、CA19-9三者单独与联合检测在胃癌骨转移中的诊断价值及其与骨转移分级之间的关系。结果骨转移组患者ALP、CEA、CA19-9水平均明显高于无骨转移组,差异均有统计学意义(P﹤0.01)。ALP、CEA、CA19-9均是胃癌发生骨转移的影响因素(P﹤0.05)。3种血清标志物联合检测的曲线下面积(AUC)大于任何指标单独检测,但ALP单独检测与三者联合检测的AUC值差异不明显;3种血清标志物联合检测诊断效能优于单独检测。ALP与CA19-9水平随着骨转移分级升高呈上升趋势。经Spearman相关分析显示,ALP、CA19-9与骨转移分级均呈正相关(r=0.436、0.391,P﹤0.05),且ALP在评价胃癌骨转移严重程度方面优于CA19-9。结论ALP、CEA、CA19-9联合检测对胃癌骨转移的诊断价值优于单项检测,为胃癌骨转移的早期诊断以及监测提供参考。但考虑到患者的经济因素,对于临床上怀疑胃癌骨转移的患者,ALP是首选的检测指标,且该指标可作为评价胃癌骨转移严重程度的生物学标志物。     

多种肿瘤标志物蛋白芯片检测系统(C-12)对老年肺癌转移诊断的临床价值研究

目的:利用多种肿瘤标志物蛋白芯片检测系统(C-12)检测老年肺癌患者各项肿瘤标志物的水平,并探讨C-12对老年肺癌患者是否发生转移的临床监测价值。方法:利用多种肿瘤标志物蛋白芯片检测系统检测年龄50岁以上的正常对照组(n=31)、肺部良性疾病组(n=23)、肺癌未转移组(n=24)以及肺癌转移组(n=33)血清12种肿瘤标志物水平并计算阳性率。结果:肺癌未转移组血清CA19-9、CEA、CA242、AFP、CA125和CA15-3的水平明显高于正常对照组(P<0.05),而肺癌转移组血清CA19-9、NSE、CEA、CA242、Fe蛋白、β-HCG、AFP、CA125、HGH和CA15-3这10项肿瘤标志物水平均显著高于正常对照组(P<0.05)。肺癌转移组与肺癌未转移组相比,CA19-9、CEA、CA242、Fe蛋白、CA15-3这5项肿瘤标志物水平和阳性率均明显升高(P<0.05)。结论:联合检测血清CA19-9、CEA、CA242、Fe蛋白、CA15-3的水平可以作为老年肺癌患者发生转移的辅助诊断指标。     

胸腔积液中肿瘤标志物检测在肺癌合并胸腔积液诊断中的应用

目的 探讨胸腔积液中癌胚抗原(CEA)、糖链抗原125(CA125)、糖链抗原199(CA199)、神经元特异性烯醇化酶(NSE)检测对肺癌合并胸腔积液的诊断价值.方法 采用化学发光法对30例肺癌合并胸腔积液患者与35例良性疾病合并胸腔积液患者的胸腔积液进行CEA、CA125、CA199、NSE测定,并根据受试者工作曲线(ROC)建立合理的临床判断界值.结果 肺癌患者胸腔积液中CEA、CA125、CA199、NSE的平均水平均明显高于良性疾病患者(P＜0.05).CEA、CA125、CA199、NSE的ROC曲线下面积分别为0.94、0.79、0.85、0.79,最佳临界值分别为16.0 μg·L-1、45.2 u·mL-1、39.3 u·mL-1、17.6 μg·L-1.CEA、CA125、CA199、NSE联合检测敏感度为96.7％,特异度为82.9％.结论 检测胸腔积液中CEA、CA125、CA199、NSE的水平对肺癌合并胸腔积液的诊断有重要价值,4种肿瘤标志物联合检测可提高诊断水平.     

CTA联合肿瘤标志物检测在胰腺癌诊断中的价值

目的：探讨 CTA 联合胰腺癌诊断常用肿瘤标志物 CA19-9、CA125、CEA 在胰腺癌诊断中的价值。方法：回顾性分析43例经病理证实并被诊断为胰腺癌的患者,所有患者均进行腹部 CTA、血清 CA19-9、CA125、CEA 多项检查,对检查结果进行分析。结果：CTA 诊断准确率约62.8%,血清 CA19-9、CA125及 CEA诊断阳性率分别为81.4%、32.6%、53.5%。CTA 联合 CA19-9、CA125及 CEA 三项时诊断效能最高,诊断准确率为97.7%。CTA 联合肿瘤标志物诊断效能优于单一 CTA（P <0.000）、CA19-9（P <0.03）、CA125（P <0.000）及 CEA（P <0.000）检查。结论：CA19-9在胰腺癌的诊断效能高于 CTA、CA125及 CEA。CTA 联合CA19-9、CA125及 CEA 三项可明显提高胰腺癌的诊断准确率。     

Clinical evaluation of the simultaneous determination of tumor markers in fluid and serum and their ratio in the differential diagnosis of serous effusions.

We evaluated the diagnostic utility of simultaneous determination of 5 tumor markers, CEA, CA 125, CA 15-3, CA 19-9 and cytokeratin 19 (CYFRA 21-1), in fluid and serum from 101 patients, 52 with pleural effusion (22 malignant) and 49 patients with ascites (14 malignant). Tumor marker concentrations in fluid from patients with malignant effusions were significantly higher than those obtained in benign fluids or serum. However, there are two types of tumor markers: those released/secreted by normal mesothelia such as CA 125 and cytokeratin 19 (higher levels in benign fluids than in serum) and non-released/secreted tumor markers (low concentrations in benign fluids) such as CEA, CA 19-9 and CA 15-3. The fluid/serum (F/S) ratio showed better sensitivity with maximum specificity than a single determination in fluid for CEA, CA 15-3 and CA 19-9, but not for CA 125 and CYFRA. The combination of a F/S ratio greater than 1.2 and a cut-off of 5 ng/ml for CEA, 30 U/ml for CA 15-3 and 37 U/ml for CA 19-9 showed sensitivities of 58, 57 and 44%, respectively, and a specificity of 100%, with a combined sensitivity of 82% for overall effusions and 79% for fluids with negative cytology with a specificity of 100%. In conclusion, the use of the F/S ratio in nonsecreted tumor markers such as CEA, CA 19-9 and CA 15-3 improve the sensitivity and specificity and allow standardization of the cut-off.     

Diagnostic value of tumor markers for differentiating malignant and benign pleural effusions of Iranian patients

In order to evaluate the diagnostic yield of tumor markers in differentiating malignant and benign pleural effusions, we carried out a prospective study in a group of Iranian people. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA15-3), neuron-specific enolase (NSE) and cancer antigen 125 (CA 125) were assayed prospectively in patients with pleural effusion (40 malignant and 37 benign). The highest sensitivity was obtained with a combination of CA 15-3 in serum, and CA 15-3 and CEA in pleural fluid (80%), also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (80%). The highest specificity was obtained with combination of CA 15-3 in serum, and CA 15-3 and NSE in pleural fluid (100%), and also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (100%).     

Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleural effusions

The aim of this study was to evaluate the individual and combined diagnostic utility of six tumor markers in patients with pleural effusion. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), cytokeratin fragment 19 (CYFRA 21-1), neuron-specific enolase (NSE) and total sialic acid (TSA) were assayed in 74 patients with pleural effusions (44 malignant and 30 benign). All tumor markers except TSA and NSE were increased in both serum and pleural fluid of patients with malignant diseases. Using the cut-off values 3 ng/ml, 14 U/ml, 5 U/ml, 8 ng/ml and 70 mg/dl for pleural fluid CEA, CA 15-3, CA 19-9, CYFRA 21-1 and TSA, respectively, the sensitivity (%) and specificity (%) of these tumor markers were as follows: CEA; 52/77, CA 15-3; 80/93, CA 19-9; 36/83, CYFRA 21-1; 91/90, TSA; 80/67, for differentiating malignant effusions from benign. When CA 15-3 and CYFRA 21-1 combined, the sensitivity and specificity were increased (100 and 83%, respectively). Classifying the malignant effusions as bronchial carcinoma and malignant pleural mesothelioma, CEA was shown to have the highest sensitivity and specificity (88 and 90%, respectively) while the combination of CEA with other tumor markers increased sensitivity but decreased specificity. According to our results, tumor markers are not suitable for the differential diagnosis of malignancy.     

良恶性胸腔积液的临床特征及预测因素分析

目的:对比分析良恶性胸腔积液的临床特征,筛选恶性胸腔积液可能的预测因素。方法:收集良性胸腔积液患者30人和恶性胸腔积液患者32人的临床资料,分析胸腔积液及血液学相关指标（胸腔积液物理性状、胸腔积液和血液学生化、肿瘤标志物）。结果:恶性胸腔积液患者的年龄明显高于良性胸腔积液患者,但二者在性别分布上无差异。恶性胸腔积液的乳酸脱氢酶（LDH）、腺苷脱氨酶（ADA）、γ-干扰素（γ-IFN）显著低于良性胸腔积液,而癌胚抗原（CEA）、糖类抗原（CA19-9）、神经特异性烯醇化酶（NSE）显著高于良性胸腔积液（P均<0.05）。两组患者血液LDH、ADA、CEA、CA19-9的差异也具有统计学意义。条件Logistic回归分析发现CEA>10ng/ml、血性胸腔积液、ADA<15U/ml、CA19-9>20U/ml为恶性胸腔积液的预测因素。结论:非肿瘤标志物（如胸水颜色、ADA值）也有助于胸腔积液性质的判断。恶性胸腔积液的预测作用由大到小依次为CEA、血性胸腔积液、ADA、CA19-9。     

Diagnostic value of pleural interleukin 17 and carcinoembryonic antigen in lung cancer patients with malignant pleural effusions

Interleukin 17 (IL-17) has been found to be increased in some human cancers; however, the possible implication of IL-17 in regulating antitumor responses in lung cancer patients with malignant pleural effusions (MPE) remains to be elucidated. This study aimed to investigate the diagnostic value of pleural IL-17 and carcinoembryonic antigen (CEA) in MPE and benign pleural effusions (BPE). Pleural effusion samples from 108 patients were classified on the basis of diagnosis as MPE (n?=?56) and BPE (n?=?52). The concentration of IL-17 was determined by enzyme-linked immunosorbent assay (ELISA). The CEA levels were also determined in all patients. A significant difference was observed in the levels of CEA (P?<?0.01) between MPE and BPE. The concentration of IL-17 in MPE was significantly higher compared to that in BPE (P?<?0.01). With a cutoff point of 15.7 pg/ml, IL-17 had a sensitivity of 76.8 % and a specificity of 80.8 % for differential diagnosis. The combined detection of IL-17 and CEA had a sensitivity of 96.4 % and a specificity of 92.3 % to distinguish MPE from BPE. The combined detection of IL-17 and CEA may be more valuable in the differential diagnosis between MPE and BPE.     

ADA,CEA和CA19—9联合检测对老年结核和肿瘤性胸水的鉴别诊断价值

探讨腺苷脱氨酶（ＡＤＡ）、癌胚抗原（ＣＥＡ）和癌抗原１９－９（ＣＡ１９－９）对老年结核和肿瘤性胸水的鉴别诊断价值。方法检测经病理确诊的≥６０岁的３２例结核性胸膜炎和２０例癌性胸水中的ＡＤＡ、ＣＥＡ和ＣＡ１９－９含量。结果单项检测：ＡＤＡ诊断结核性胸膜炎的敏感性为５７．３％，特异性为９５％，准确度为９５％；ＣＥＡ和ＣＡ１９－９诊断肿瘤性胸水的敏感性分别为６５％和７０％，特异性为８８％和９４％，准确度为７５％和８８％。联合检测：以三项同时符合结核或癌性胸水为诊断依据时，结核和癌性胸水的敏感性分别为５０％和６５％，特异性和准确度均为１００％。结论ＡＤＡ、ＣＥＡ和ＣＡ１９－９联合检测对老年结核与癌性胸水有较高的鉴别诊断价值。     

Clinical evaluation of various tumor markers in pleural effusion and in the serum

Various tumor markers and enzymes in the pleural effusion and serum have been measured in 47 patients with carcinoma and in 43 patients with benign disease, by means of a radioimmunoassay and biochemical methods. CEA in the pleural effusion showed a high specificity and sensitivity for the detection of the malignancy. In patients with a lung cancer, measurement of the NSE in the serum was more useful than in the pleural effusion. Further, both CA19-9 and SCC in the pleural effusion showed a high specificity in a differential diagnosis of cancer and benign diseases. On the other hand, CA 125, TPA and IAP in the pleural effusion and in the serum showed a high sensitivity, but a low specificity for diagnosing the malignancy. The levels of ADA were significantly higher in tuberculous pleural effusions than in carcinomatous effusions. Therefore, this suggests that measurement of the various tumor markers in both the pleural effusion and in the serum is useful in achieving a differential diagnosis of malignant and benign diseases.     

Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions

Carcinoembryonic antigen (CEA), carbohydrate antigens 15-3, 19-9 and 72-4 (CA 15-3, CA 19-9 and CA 72-4), cytokeratin 19 fragments (CYFRA 21-1), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC) were evaluated in pleural fluid for the diagnosis of malignant effusions. With a specificity of 99%, determined in a series of 121 benign effusions, the best individual diagnostic sensitivities in the whole series of 215 malignant effusions or in the subgroup of adenocarcinomas were observed with CEA, CA 15-3 and CA 72-4. As expected, a high sensitivity was obtained with SCC in squamous cell carcinomas and with NSE in small-cell lung carcinomas. CYFRA and/or CA 15-3 were frequently increased in mesotheliomas. Discriminant analysis showed that the optimal combination for diagnosis of non-lymphomatous malignant effusions was CEA + CA 15-3 + CYFRA + NSE: sensitivity of 94.4% with an overall specificity of 95%. In malignant effusions with a negative cytology, 83.9% were diagnosed using this association. The association CYFRA + NSE + SCC was able to discriminate adenocarcinomas from small-cell lung cancers. Regarding their sensitivity and their complementarity, CEA, CA 15-3, CYFRA 21-1, NSE and SCC appear to be very useful to improve the diagnosis of malignant pleural effusions.