磁共振胆胰管成像联合肿瘤标记物CA19—9在胆管癌诊断中的价值

目的：探讨磁共振胆胰管成像（MRCP）联合肿瘤标记物CA19－9在胆管癌中的诊断价值。方法：回顾性分析26例手术及病理主实为胆管癌和22例胆道良性疾病病人的术前MRCP影像特点，并结合血清肿瘤标记物CA19－9的检测进行评价。结果：MRCP诊断的敏感性为88％，特异性为84％，阳性预测值为85％，阳性似然比为5．5；CA19－9的敏感性为82％，特异性为79％，阳性预测值为84％，阳性似然比为3．9。联合诊断的敏感性为92％，特异性为88％，阳性预测值为96％，阳性似然比为7．7。结论：MRCP联合血清CA19－9的检测，提高了对胆管癌诊断的准确性。     

CA50、CA19-9、CEA联检在胰腺疾病诊断中的价值

目的 :分析CA19- 9、CEA和CA5 0在胰腺疾病诊断中的价值。方法 :4 6 9例胰腺疾病患者采用放射免疫分析测定血清CA5 0水平。采用电化学发光法测定血清CA19- 9和CEA水平。结果 :诊断胰腺癌 ,CA19- 9敏感性和特异性分别为 92 5 7%和 90 73% ;联合检测CA19- 9、CEA、CA5 0其敏感性提高为97 6 4 %。阳性诊断率为 99 16 %。结论 :采用以CA19- 9为主的肿瘤标志物联合检测 ,对胰腺疾病 ,特别是胰腺癌的诊断有着极其重要的意义。     

血清肿瘤标志物测定联合应用对结直肠癌术后复发与转移探测的临床诊断价值

目的 评价部分肿瘤标志物测定联合应用探测结直肠癌术后复发、转移灶的效能.方法 研究对象为资料完整的90例结直肠癌患者.所有患者均检测血清CEA,部分患者2周内进行了CA19-9及CA242的监测.根据病理及临床随访结果,分别计算各项肿瘤标志物(单个指标、串联指标、并联指标)诊断结直肠癌术后复发及转移的灵敏度、特异性、阳性预测值、阴性预测值及准确度.结果 CEA提示结直肠癌复发及转移灶的灵敏度为74.03％、特异性为46.15％、阳性预测值为89.06％、阴性预测值为23.08％.CA19-9的灵敏度为31.88％、特异性为72.73％、阳性预测值为88.00％、阴性预测值为14.55％.CA242的灵敏度为37.50％、特异性为63.34％、阳性预测值为85.71％、阴性预测值为14.89％.肿瘤标志物指标串联结果:CEA与CA19-9,诊断效能灵敏度为26.09％、特异性为72.73％、阳性预测值为85.71％、阴性预测值为13.56％;CEA与CA242,诊断效能为灵敏度为32.81％、特异性为72.73％、阳性预测值为87.50％、阴性预测值为15.69％;CA19-9与CA242,灵敏度为25.00％、特异性为72.73％、阳性预测值为84.21％、阴性预测值为14.29％;CEA、CA19-9、CA242,灵敏度为23.44％、特异性为72.73％、阳性预测值为83.33％、阴性预测值为14.04％.指标并联结果:CEA与CA19-9并联,灵敏度为76.81％、特异性为45.45％、阳性预测值为89.83％、阴性预测值为23.81％;CEA与CA242并联,灵敏度为73.44％、特异性为36.36％、阳性预测值为87.04％、阴性预测值为19.05％;CA19-9与CA242并联,灵敏度为42.19％、特异性为63.64％、阳性预测值为87.10％、阴性预测值为15.91％;CEA、CA19-9、CA242并联后,灵敏度为78.13％、特异性为36.36％、阳性预测值为87.72％、阴性预测值为22.22％.结论 肿瘤标志物的联合应用可提升结直肠癌术后复发及转移灶的探测效能.     

血清CA19-9、CA242和CA50在胰腺癌诊断中的应用

目的 探讨血清肿瘤标志物CA19-9、CA242和CA50单项检测及联合检测在胰腺癌诊断中的应用价值.方法 选取胰腺癌患者59例(胰腺癌组)、胰腺良性疾病患者64例(胰腺良性疾病组),采用直接化学发光方法对患者血清中CA19-9、CA242、CA50水平进行检测,并比较分析单一肿瘤标志物检测及联合检测的的诊断价值.结果 胰腺癌患者血清CA19-9、CA242、CA50水平显著高于胰腺良性疾病组(P＜0.05),肿瘤标志物单项检测,CA19-9敏感性最高(81.36％),CA242特异性最高(84.78％),联合检测可提高检测的敏感性(平行试验联合检测)和特异性(系列试验联合检测).结论 CA19-9、CA242、CA50的联合检测对胰腺癌的诊断提供重要参考依据,具有较高的临床价值.     

肿瘤标志物联合MRCP对肝外胆道梗阻的临床应用研究

评价肿瘤标志物与MRCP联合对肝外胆道梗阻的鉴别诊断价值.采用化学发光免疫分析法测定97例肝 外胆道梗阻患者血清CA19-9、CA125及CEA水平,行MRCP显像并进行统计分析.CA19-9在恶性梗阻时的阳 性率明显高于CEA和CA125(P<0.01),与MRCP联合检查,诊断准确性可达100%.血清CA19-9检测与 MRCP结合鉴别诊断肝外胆道梗阻不仅能提供精确的定位信息,而且可以进行准确的定性判断;CEA和CA125 还可以为恶性梗阻的腹腔转移提供可靠信息.     

血清SCCA、CEA、CA125、CA19-9联合检测在宫颈癌与癌前病变鉴别诊断中的应用价值

目的探讨血清鳞状细胞癌抗原(SCCA)、癌胚抗原(CEA)、糖链抗原125(CA125)、糖链抗原199(CA19-9)联合检测在宫颈癌和宫颈癌前病变(CIN)鉴别诊断中的应用价值。方法回顾性分析2017年6月至2018年6月间收治36例CIN患者(CIN组)和68例宫颈癌患者(宫颈癌组)临床资料,并选取同期行健康体检者30例作为对照组。比较三组受试者血清肿瘤标志物SCCA、CEA、CA125、CA19-9水平,评估不同血清肿瘤标志物诊断宫颈癌的结果 ,绘制ROC曲线评估不同血清肿瘤标志物单独及联合检测诊断宫颈癌的效能。结果①三组SCCA、CEA、CA125、CA19-9对比,差异均有统计学意义(P<0.05);宫颈癌组SCCA、CEA、CA125、CA19-9均高于CIN组和对照组(P<0.05);CIN组SCCA、CEA、CA125、CA19-9均高于对照组(P<0.05);②SCCA、CEA、CA125、CA19-9单独诊断中,SCCA灵敏度、准确率、阳性预测值、阴性预测值及AUC均最高,CA125特异性最高;SCCA+CEA+CA125+CA19-9联合诊断的灵敏度、特异性、准确率、阳性预测值、阴性预测值及AUC均最高。结论宫颈癌、CIN和正常人群SCCA、CEA、CA125、CA19-9水平差异显著,SCCA、CEA、CA125、CA19-9联合诊断宫颈癌具有较高的诊断效能。     

血清肿瘤标志物CEA、CA724、CA242、CA19-9联合检测诊断肺癌的临床价值分析

目的 分析血清肿瘤标志物癌胚抗原(CEA)、糖类抗原724(CA724)、糖类抗原242(CA242)、糖类抗原19-9(CA19-9)联合检测与肺癌诊断及预后的相关性.方法 选取2014年5月至2017年1月我院收治的肺癌患者120例为研究对象,并纳入观察组,以同期入院体检的良性肺疾病患者55例为对照组,测定两组血清CEA、CA724、CA242、CA19-9水平,对比四种肿瘤标志物在不同病理类型肺癌中表达水平,分析CEA、CA724、CA242、CA19-9联合检测与单项、2联、3联检测诊断肺癌的灵敏度、特异度、准确度、阳性预测值、阴性预测值,比较CEA、CA724、CA242、CA19-9阳性或阴性患者在预后随访中无复发生存率、远处转移率.结果 观察组血清CEA(30.24±1.75)μg/L、CA724(14.85±1.11)kU/L、CA242(38.18±1.05)kU/L、CA19-9(41.24±1.57)kU/L均较对照组高(P<0.05);CEA、CA242在腺癌中表达水平最高,CA724、CA19-9在腺癌与鳞癌中表达水平差异无统计学意义(P>0.05);CEA、CA724、CA242、CA19-9联合检测诊断肺癌的灵敏度98.18%、准确度80.00%、阴性预测值80.00%,均高于上述指标单项或2联、3联检测(P<0.05);CEA、CA724、CA242、CA19-9阳性患者与阴性患者比较,无复发生存率明显较低,远处转移率显著较高(P<0.05).结论 血清肿瘤标志物CEA、CA724、CA242、CA19-9联合检测诊断肺癌的灵敏度、准确度较单项、2联及3联检测明显提高,且上述指标可用于预测预后,值得在临床推广应用.     

肿瘤标志物联合检测对消化系统肿瘤的诊断价值

探讨甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、糖类抗原125（CA-125）联合检测对消化系统恶性肿瘤的筛查作用及其适用人群。比较我院行AFP、CEA、CA19-9、CA-125榭则的恶性肿瘤患者和良性消化系疾病患者的四项肿瘤标志物的含量,计算并比较其灵敏度、特异性、准确性、阳性预测值及阴性预测值。结果发现,联合检测CA-125＋CA19-9能明显提高消化道空腔器官的恶性肿瘤诊断的灵敏度,但特异性及阳性预测值下降。联合检测更多的肿瘤标志物并不能使诊断准确性提高。对于消化系统实质器官的恶性肿瘤来说,联合检测肿瘤标志物无实际应用价值。去除肝硬化患者、良性胆道疾病及病毒性肝炎患者可明显提高特异性及灵敏度,联合检测CA-125＋CA19—9对于合适的患者有助于提高消化系统空腔器官恶性肿瘤的早期检出率。     

肝胆管结石并胆管癌患者血清CA19-9阳性值分析

肿瘤标志物的敏感性和特异性是评价肿瘤标志物的两个重要指标。CA19-9已广泛应用于消化道肿瘤特别是胰腺癌、胆管癌的诊断、疗效监测及复发和预后的预测,尤其是肝胆管结石是否合并胆管癌变的鉴别。但在实际工作中,一些胆道良性疾病如肝胆管结石的患者,血清CA19-9有明显或不同程度的增高,假阳性率较高。为此,我们选择2005年1月至2010年8月间CA19-9阳性的肝胆管结石住院患者110例,并选择同期经手术和病理证实为肝胆管结石并胆管癌(HCWC)的患者40例,将其血清CA19-9含量与30名健康人作对照,现报道如下。     

血清CEA、AFP、CA19-9和SA联检对HCC的诊断价值

目的：探讨了肿瘤标志物癌胚抗原（CEA）、甲胎蛋白（AFP）、糖类抗原CA19-9（CA19-9）和唾液酸（SA）联检对原发性肝癌（HCC）的临床评价。方法：应用放免法和生化法对36例HCC患者进行了血清CEA、AFP、CA19-9和SA检测,并与35名正常健康人作比较。结果：以单一指标阳性作为诊断标准,CEA、AFP、CA19-9和SA对HCC的敏感性分别为33.3%、69.4%、58.3%、61.1%,特异性分别为60.4%、81.3%、68.8%、64.6%。联检结果二项或二项以上阳性作为标准。本文患者诊断灵敏度为94.4%、特异性为95.8%。结论：联检血清CEA、AFP、CA19-9和SA对HCC的辅助诊断有较高的临床实用价值。     

Level of functioning of siblings and parents of probands of varying degrees of retardation

A further analysis of already published data supports the position that retardates of low ability level less frequently have retarded siblings, retarded parents, and parents low in occupational level than do retardates higher in ability level. The analysis supports the position that there are two types of retarded individuals, persons retarded as a result of gene or chromosomal anomalies, brain injury, etc., who more frequently occur in the lower-level retardate group, and persons whose retardation represents polygenic segregation, who more frequently occur in the higher-level group.     

Modes of Inheritance of Errors of Refraction

Eighteen families in which both parents had refractions within the range of +4·0 D to −4·0 D and axial lengths seen in emmetropia (22·3-26·0 mm) showed coefficients of correlation of the order 0·5 indicative of polygenic inheritance. Such coefficients were seen for axial length (0·407) and for the cornea (0·487), but not for the lens (which is known to be yoked to the axial length). No such coefficients were seen in 19 families in which one of the parents had axial length outside the emmetropic range (nine families with long axes and 10 with short axes).

The pattern of polygenic inheritance for emmetropia (completely correlated optical components) and errors of refraction up to 4·0 D (inadequately correlated components: correlation ametropia) follows that seen in stature and other measurable characters. In contrast the high refractive errors with their abnormal axial lengths (component ametropia) are—like the extremes in stature—pathological anomalies with monofactorial inheritance.

     

Aspects of the problem of direct introduction of Standards of International Organizations

Editorial note. This article is published as part of a discussion. Particular issues of the article are disputable. First of all, this concerns the so-called “folder” method of introduction of international standards for medical devices to domestic medical practice (i.e., by direct translation of the standards and their publication as standardizing documents). Nevertheless, at least one of the problems, the problem of coordination between domestic state standards for medical devices and international recommendations of ISO and IEC, is undoubtedly of topical importance. Advancement of new health service legislation which is to be approved by law-makers will definitely introduce corrections into the present situation. The Editorial Board of Meditsinskaya Tekhnika believes this article will lessen these problems and to be welcomed by readers.