胰腺癌血清肿瘤标记物联合检测的临床研究

目的：观察胰腺癌患者血清肿瘤标记物的表达,寻找对胰腺癌诊断与随访的有价值血清肿瘤标记物。方法：采用免疫分析法和放射免疫法检测92例胰腺癌患者的血清AFP、CEA、CA50、CA15－3、CA19－9、CA72－4、CA125和CA242共8种肿瘤标记物的表达,并与其它恶性肿瘤患者70例和良性疾病患者73例作对照,分析其临床诊断价值。结果：8种肿瘤标记物中CA19－9、CA242、CA50和CA125对胰腺癌诊断的相对价值较高,尤以CA19－9的诊断价值最高,灵敏度和特异度分别为82．6％和81．3％,平行法联合检测提高灵敏度至90．2％,系列法联合检测提高特异度93．5％,25例获手术切除者术后上述四项指标呈下降趋势。结论：血清CA19－9、CA242、CA50和CA125的检测对胰腺癌的诊断和随访是价值的,联合检测可以增加检测效率。     

肿瘤标志物CEA、CA19-9、CA50联合检测在胆管癌诊治中的作用

目的 寻找对胆管癌诊断、疗效判断和随访有价值的肿瘤标志物。方法 采用RIA联合检测34例经手术和病理证实胆管癌和21例胆囊息肉患者血清中CEA、CA19-9、CA50的水平，并对其中15例根治性切除的胆管癌患者进行随访。结果 血清CA19-9的敏感性和特异性最好，分别为80．15％和92％；胆管癌根治性切除后，患者血清CA19-9、CA50水平较术前明显降低。结论 肿瘤标志物联合检测对胆管癌术前诊断、疗效评价和随访有价值。     

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目的 探讨多种血清肿瘤 民物联合检测在胰腺癌诊治中的应用价值。方法 采用荧光免疫分析法和放射免疫法检测胰腺癌病人的血清CA50、CA19－9、CA125和CA242的表达，重点动态观察胰腺癌诊治过程中肿瘤标志物的表达及其临床随访价值。结果 CA19－9、CA242、CA50和CA125平行联合检测可提高胰腺癌诊断的敏感性（90.2%），系列联合检测可提高其特异性（93.5%）；结合电子束断层摄影（EBCT）检查，更可增加胰腺癌诊断的敏感性（98.6%）和特异性（94.6%）。动态监测术后多种肿瘤标志物有助于肿瘤复发和转移的随访。结论 动态联合检测CA19－9、CA242、CA50和CA125结合EBCT检查，可增加胰腺癌诊断的敏感性和特异性。     

血清CA19-9、CA242、CEA及CA125在胰腺癌诊断和预后中的价值

目的探讨CA19-9、CA242、CEA和CA125四种肿瘤标志物单独检测或联合检测在胰腺癌诊断和预后中的价值。方法测定并分析我院2007年1月至2009年12月期间收治的63例胰腺癌患者、33例胆管癌和27例胰腺良性疾病患者血清中CA19-9、CA242、CEA和CA125水平,并对术后胰腺癌患者进行随访。结果胰腺癌患者血清中CA19-9、CA242、CEA和CA125水平明显高于胰腺良性疾病患者和胆管癌患者(P<0.05)。单项检测中血清CA19-9的敏感性最高,达79.4%(50/63),但其特异性(61.7%)低于CA242(83.3%)和CEA(80.0%)。联合检测CA19-9+CA242+CEA的特异性最高,达93.3%(56/60)。当肿瘤位于胰腺体/尾部时CA19-9水平显著高于其在胰腺头部或全胰腺时(P<0.05)。胰腺癌Ⅳ期患者的CA19-9和CA242水平显著高于Ⅰ或Ⅱ/Ⅲ期患者(P<0.05)。本组失访15例,48例获得随访,随访时间平均6个月(2~12个月)。胰腺癌患者术后0.5及3个月血清中CA242、CA19-9较术前明显降低(P<0.05)。结论单项检测CA19-9可以提高胰腺癌诊断的敏感性,联合检测CA19-9+CA242+CEA可以提高胰腺癌诊断的特异性,CA19-9和CA242对胰腺癌的治疗效果及预后判断更具有价值。     

血清CA153、CA125及CA19-9检测对乳腺癌的诊断价值

目的探讨血清CA153、CA125和CA19-9检测对乳腺癌早期诊断的价值。方法采用化学发光免疫法分别检测乳腺癌、乳腺良性疾病患者及正常健康体检者血清CA153、CA125和CA19-9的水平。结果乳腺癌患者血清的CA153、CA125和CA19-9的表达水平及表达阳性率均明显高于正常对照者和乳腺良性疾病患者(P<0.01);乳腺癌患者术后CA153、CA125及CA19-9表达水平较术前明显下降(P<0.01),与正常对照者比较差异无统计学意义(P>0.05)。结论肿瘤标志物CA153、CA125及CA19-9对乳腺癌有一定的诊断价值,且可作为监测乳腺癌病情进展、评估治疗疗效及预后的指标。     

血浆K-ras突变联合CA19-9检测对胰腺癌的诊断价值

目的: 探讨血浆K-ras基因突变联合CA19-9检测对胰腺癌的诊断价值.方法: 对连续58例疑为胰腺肿瘤患者,入院时抽取外周静脉血,分离血浆并提取DNA.采用突变富集PCR-RFLP法分析K-ras基因密码子12突变,用放射免疫法测定血清CA19-9.所有病例的血标本分析均在术前完成,并将检测结果与手术探查、病理诊断进行比较.结果: 41例胰腺癌患者中,血浆K-ras基因突变者29例(占70.7%),血清CA19-9升高者30例(占73.2%).联合K-ras与CA19-9检测胰腺癌的敏感性为90.2%(37/41).在其他17例非胰腺癌患者中,有3例血浆K-ras突变,8例血清CA19-9有升高.结论: 血浆K-ras突变可能是诊断胰腺癌的一个有价值的指标,若同时测定血清CA19-9,可提高检测胰腺癌的敏感性.     

CT联合血清CEA、CA19-9检测对胰腺癌诊断价值分析

目的:探讨CT联合血清癌胚抗原(CEA)、糖链抗原(CA19-9)检测在胰腺癌诊断中的意义.方法:回顾性分析35例经手术病理证实的胰腺癌患者,对CT及血清CEA、CA19-9检查结果进行比较,分析CT联合血清CEA、CA19～9检测对胰腺癌的诊断价值.结果:联合检测的确诊率明显高于CT影像检查、血清肿瘤标志物CEA、CA19-9单独检测,联合检测与各单项检测之间比较差异均有统计学意义(P＜0.05).结论:CT影像联合血清肿瘤标志物CEA、CA19-9检测有助于胰腺癌的临床诊断.     

肿瘤标记物联合检测对胆囊良恶性病变的诊断价值

目的：观察胆囊癌患者血清肿瘤标记物的表达,分析血清肿瘤标记物联合检测在胆囊癌诊断中的作用。方法：实验组50例胆囊癌患者,采用酶联免疫吸附法检测血清AFP和CEA的表达,用荧光免疫分析法检测血清CA19—9的表达,用放射免疫法检测血清CA50的表达,以同期的40例胆囊息肉作对照,分析其临床诊断价值。结果：四种血清肿瘤标记物中CA50、CA19—9和CEA对胆囊癌诊断有较高价值,平行法联合检测可使诊断的灵敏度提高至88％,系列法联合检测可使特异度提高至95％。结论：血清CAS0、CA19—9和CEA的联合检测对胆囊癌的诊断是有临床价值的,联合检测可以增加诊断的特异度和灵敏度。     

多肿瘤标志物的联合检测和分析对胰腺癌诊断的价值探讨

目的探讨肿瘤标志物的联合检测和分析对胰腺癌诊断的价值。方法应用蛋白芯片技术同时检测CA19-9、CEA、CA242、-βHCG、AFP、Free-PSA、Ferritin、NSE、PSA、CA125、CA15-3和HGH共12种肿瘤标志物在患者血清中的表达。试验分3组:胰腺癌组81例,良性胰腺病组57例,正常对照组547例。结果12种肿瘤标志物在胰腺癌、良性胰腺病和健康对照组之间表达的差异明显。总的表达强度为胰腺癌组>良性胰腺病组>健康对照组。胰腺癌组中CA19-9、CEA、CA242、β-HCG、AFP、CA125和HGH的表达强度显著高于良性胰腺病组(P<0.05)。同时CA19-9、CEA、CA242、Fer-ritin、-βHCG、AFP、CA125、HGH和CA15-3的阳性率也明显高于良性胰腺病组(P<0.05)。CA242、CA19-9、CEA和CA125对胰腺癌诊断的敏感性均高于50%,特异性均高于70%,准确性均高于60%。其中以CA242的敏感性、特异性和准确性最高,分别为72.8%、89.5%和79.7%。同时CA242、CA19-9和CEA联合检测的敏感性和准确性较之单项检测明显升高。两两联合的准确性均为85.9%以上,3种联合准确性则高达97.8%。结论肿瘤标志物CA242、CA19-9和CEA的联合检测可明显提高胰腺癌的诊断率。     

血清AFP、CA125、CA19-9的联合检测对原发性肝癌的诊断研究

目的 通过对血清中的AFP、CA125、CA19-9的联合测定，提高对原发性肝癌的诊断率。方法 用ELISA方法对64例味发性肝癌患者、46例肝硬化患者进行肿瘤标记物AFP、CA125及CA19-9的血清学检测．42例正常人作为对照组。结果 在64例原发性肝癌患者中，单纯运用AFP诊断原发性肝癌，其诊断率仅为62．5％；而运用AFP、CA125、CA19-9的联合检测诊断原发性肝癌，其诊断率可提升至90．6％。结论 联合测定血清中AFP、CA125、CA19-9对提高原发性肝癌的诊断率有一定的临床应用价值。     

血清肿瘤标记物联合检测在胰腺癌诊治中的作用

目的：观察胰腺癌患者血清肿瘤标记物的表达,分析血清肿瘤标记物联合检测在胰腺癌诊治中的作用。方法：采用荧光免疫分析法和放射免疫法检测９５例胰腺癌患者的８种血清ＡＦＰ、ＣＥＡ、ＣＡ５０、ＣＡ１５－３、ＣＡ１９－９、ＣＡ７２－４、ＣＡ１２５和ＣＡ２４２肿瘤标记物的表达,并与其他７０例恶性肿瘤患者和７３例良性疾病患者作对照,分析其临床诊断价值。对２５例胰腺癌手术切除患者进行术后肿瘤标记物的连续监测。结果：８种肿瘤标记物中ＣＡ１９－９、ＣＡ２４２、ＣＡ５０和ＣＡ１２５对胰腺癌诊断有较高价值;平行法联合检测可使诊断的灵敏度提高至９０．２％,系列法联合检测可使特异度提高至９３．５％。介入治疗对肿瘤标记物的表达影响不明显,手术切除肿瘤后,肿瘤标记物的水平显著下降。结论：血清ＣＡ１９－９、ＣＡ２４２、ＣＡ５０和ＣＡ１２５的检测对胰腺癌的诊断和随访是有临床价值的,联合检测可以增加诊断的特异度和灵敏度。     

肿瘤标志物CA19-9、CA242、CEA和CA125联合检测在胰腺癌诊断中的意义

目的 探讨肿瘤标志物CA19-9、CA242、CEA和CA125单项检测和联合检测对胰腺癌患者的临床诊断价值.方法 检测48例胰腺癌患者以及48例健康体检者外周血清中四种肿瘤标志物的水平,并对结果进行分析.结果 胰腺癌患者血清中CA19-9、CA242、CEA与CA125的含量显著高于正常时照组,两者比较差异有统计学意义(P<0.01).单项检测时CA19-9、CA242、CEA与CA125的敏感性分别为79.2%、54.2%、50.0%和35.4%.特异性分别为87.5%、89.6%、79.2%和70.8%.联合检测时敏感性为93.8%,特异性为100%.结论 CA19-9、CA242、CEA与CA125联合检测敏感性和特异性都明显高于单项检测.联合检测较单项血清标志物检测能提高胰腺癌的诊断率.     

CA125 is Superior to CA19-9 in Predicting the Resectability of Pancreatic Cancer

Background

Although carbohydrate antigen 19-9 (CA19-9) has been reported as a biomarker to predict the resectability of pancreatic cancer, several limitations have restricted its clinical use.

Methods

The potential of several serum tumor markers (CA19-9, CA125, CA50, CA242, CA724, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP)) to predict the resectability of pancreatic cancer was evaluated by receiver operating characteristic (ROC) analysis in a series of 212 patients with proven pancreatic cancer.

Results

Compared with other tumor markers including CA19-9, CA125 has a superior predictive value (CA19-9, ROC area 0.66, cutoff value 289.40 U/mL; CA125, ROC area 0.81, cutoff value 19.70 U/mL). In addition, for patients with unresectable diseases misjudged by CT as resectable, the percentage of CA125 over selected cutoff value was higher than that of CA19-9 (CA19-9, 70.27 %; CA125, 81.08 %).

Conclusion

CA125 is superior to CA19-9 in predicting the resectability of pancreatic cancer. Aberrant high levels of CA125 may indicate unresectable pancreatic cancer.     

六种血清肿瘤标志物在胰腺癌临床诊断中的意义

目的：评价血清肿瘤标志物检测对胰腺癌的诊断及胰腺良恶性疾病的鉴别诊断的价值。方法：回顾性分析191例患者血清中CA19-9、CA242、CA125、CA50、癌胚抗原（CEA）及甲胎蛋白（AFP）水平,将胰腺癌与肝脏恶性肿瘤、胃肠道恶性肿瘤、胆道恶性肿瘤及其他良性疾病进行对比,分析其临床价值;同时与胰腺良性占位进行比较,分析肿瘤标志物在已明确的胰腺占位性病变中的鉴别诊断价值。绘制各肿瘤标志物的ROC曲线,计算曲线下面积（AUC）并进行分析处理。结果：6种肿瘤标志物中,CA19-9、CA50和CA242水平在胰腺癌组均高于胰腺良性疾病组、肝脏恶性肿瘤组、胃肠道恶性肿瘤组和其他良性疾病组,差异有统计学意义（P〈0.05）。胰腺癌组CA125、CEA水平亦高于胰腺良性疾病组（P〈0.05）。CA19-9的敏感性为79.49%,阴性似然比为0.28,其AUC为0.925。结论：CA19-9、CA50和CA242对胰腺与非胰腺疾病鉴别有意义;CA19-9对胰腺肿瘤良恶性鉴别的综合诊断能力较其他肿瘤标志物强,对胰腺恶性肿瘤与胆道恶性肿瘤鉴别能力较差。     

Tumour markers in pancreatic cancer

Patients with pancreatic cancer usually lack signs and symptoms in the early course of the disease. Even when malignancy is suspected, differential diagnosis between benign and malignant pancreatic disorders may be difficult with current methods. An increasing interest has been focused on the utility of immunological tumour markers. CEA has been widely used since the early seventies, but the results in diagnosis of pancreatic cancer have been disappointing. Tumour marker tests for CA 19-9 and CA 50 are based on monoclonal antibodies to colonic carcinoma cell lines. CA 19-9 and CA 50 are strongly expressed in most tissue specimens from pancreatic carcinomas, but are also found in normal pancreas and benign pancreatic diseases. The CA 19-9 and CA 50 antigens are shed or released into the circulation, and are found in increased concentrations in 70-80% of patients with pancreatic cancer. Also 50-65% of patients with small resectable carcinomas have elevated CA 19-9 and CA 50 levels, although very high serum concentrations usually indicate advanced disease. Slightly elevated serum CA 19-9 and CA 50 levels are seen in some patients with benign pancreatic diseases, more often in acute than in chronic pancreatitis. Elevated values are often observed in patients with benign obstruction of the common bile duct, particularly in patients with cholangitis. In patients with jaundice of hepatocellular origin, the CA 19-9 and CA 50 levels are lower than in extrahepatic cholestasis. CA 19-9 and CA 50 have better diagnostic accuracy for pancreatic cancer than CEA, CA 125, DU-PAN-2, TPA and PSTI/TATI. However, the sensitivities and specificities of CA 19-9 and CA 50 are too low for screening of an asymptomatic population. Nevertheless, CA 19-9 and CA 50 have in our experience shown to be useful complements to other diagnostic methods in symptomatic patients with suspicion of pancreatic cancer. Combinations of different markers improve the sensitivity only slightly compared to the use of CA 19-9 or CA 50 alone. Follow-up using CA 19-9 and CA 50 is a simple and sensitive way of monitoring the postoperative course of patients with pancreatic cancer, and may give a lead time of several months for a recurrence compared to conventional methods.     

胃癌和大肠癌患者血清肿瘤标志物联合检测的临床意义

目的评价血清肿瘤标记物联合检测对胃癌和大肠癌诊断和监测的价值.方法用PC-12多种肿瘤标志物蛋白芯片检测系统检测179例胃癌和大肠癌患者、82例胃和结直肠良性疾病患者及160例健康人血清中12种常见肿瘤标志物CA19-9、NSE、CEA、CA242、铁蛋白（Ferritin）、Beta-HCG、AFP、free-PSA、PSA、CA125、HGH、CA153的水平.结果肿瘤组的肿瘤标志物水平显著高于良性疾病组及健康组（P＜0.01）,其中CA19-9、CEA、CA242、CA125和CA153 5项在胃癌和大肠癌患者中水平较两对照组明显升高,差异有统计学意义（P＜0.01）.采用平行检测法,可以提高检测的敏感度（72.07%）和阴性预测值（79.25%）;采用系列检测,可提高检测的特异度（92.15%）和阳性预测值（84.67%）.肿瘤根治术后,肿瘤标记物水平显著下降.术后未降至正常者,复发或转移率为68.89%,而术后再升高者复发或转移率为77.78%.结论多种肿瘤标记物对胃癌和大肠癌的诊断、监测肿瘤复发和转移有一定的价值.