用Western blot法区分胆道、胃部疾病癌胚抗原及其相关物质的研究

目的提高CEA诊断消化道恶性肿瘤的特异性.方法采用ELISA法分别测定消化道良、恶性疾病患者血液、消化液(胆汁、胃液)中CEA含量,进一步应用Western blot半干转移技术区分CEA及CEA相关物质.结果消化道恶性肿瘤患者消化液中CEA水平明显高于血液中CEA水平(P＜0.01),消化道良性疾病患者消化液中CEA水平与血液中CEA水平相比差异无统计学意义;消化道恶性肿瘤患者消化液中CEA水平明显高于消化道良性疾病患者消化液中CEA水平(P＜0.01),消化道恶性肿瘤患者血液中CEA水平亦明显高于消化道良性疾病患者血液中CEA水平(P＜0.05).除4例CEA含量过低(＜5 μg/L)者外所有消化道恶性肿瘤患者消化液经Western blot检测均表现出一条相对分子质量为210×103的特异条带,而消化道良性疾病患者消化液中均不含有该条带.结论采用消化液并结合Western blot技术可提高CEA诊断消化道恶性肿瘤的特异性.     

胆管结石患者血清及胆汁中肿瘤标志物的测定

目的:研究胆管结石患者血清及胆汁中肿瘤标志物的水平,了解肝功能生化指标与肿瘤标志物检测的关系。方法:通过ERCP抽取胆道结石患者的胆汁,采用放射免疫测定法测定44例胆道结石患者血清及胆汁中癌胚抗原(CEA)和糖链抗原(CA199)的含量,确定胆道结石患者血清及胆汁中2种肿瘤指标的水平;结合患者肝功能检查结果,分析与肿瘤标志物检测可能相关的肝功能指标。结果:胆汁及血清肿瘤指标在胆道结石患者中均升高,胆汁CEA及CA199平均水平均明显高于血清CEA及CA199的平均水平(P<0.05);血清CA199在梗阻性黄疸患者中升高更明显,而血清CEA的异常比例较CA199异常的更少(P<0.05);血清及胆汁CEA,CA199水平与肝功能各项指标无明显关系。结论:测定胆汁CEA及CA199的临床意义有限;血清CA199在存在胆道结石等梗阻因素时,其升高亦无临床意义。     

国外医学文摘：胆道疾病患者胆汁癌胚抗原殛癌胚抗原相关物质分析

癌胚抗原(CEA)作为一种肿瘤标志物在很多肿瘤患者的组织及体液中都可以测到。胆汁中CEA相关物质包括非特异性交叉反应性抗体(NCA)和胆汁糖蛋白1(BGP1)近来已有报告。这些物质有着共同的免疫球蛋白似的区域而被归属于CEA基因家族成员。作者采用韦斯特印迹法(Western Blot)测定了胆石及胆道肿瘤患者胆汁中CEA及CEA相关物质，目的在于从越来越多不明原困CEA增高中澄清出有意义的疾病。     

胆道梗阻病人胆汁中肿瘤标志物的变化及临床意义

目的 探讨胆汁癌胚抗原(CEA)、CA19-9、CAl25检测在胆道梗阻病人中的临床意义.方法 选择经手术或(和)病理检查证实的胆道恶性病变致胆道梗阻32例(胆道恶性病变组),与同期胆道良性病变致胆道梗阻36例(胆道良性病变组),分别检测其血清和胆汁中的CEA、CA19-9、CA125含量,并对其进行分析比较.结果 胆...     

胆汁蔓陀罗凝集素结合活力联合癌胚抗原测定诊断胆管癌

目的：研究胆汁蔓陀罗凝集素结合活力（DLBA）联合癌胚抗原测定诊断胆管癌的价值。方法：采用酶联凝集素测定法（ELLA）检测31例胆管癌及13例良性胆道疾病胆汁糖蛋白蔓陀罗凝集素（DSA）结合活力，同时采用放免测定法检测CEA水平，并评价两种方法对胆管癌的联合诊断价值。结果：胆汁DLBA，CEA的分界值分别为0.8uDLBA/ml和7.0ng/ml时，DSA－ELISA及CEA放免测定诊断胆管癌的阳性率分别为74.2%,80.6%，特异性均为100％。联合诊断（CEA或DLBA升高）的阳性率为96．8％，特异性为100％。结论：胆汁蔓陀罗凝集素结合活力联合癌胚抗原测定有助于胆管癌的诊断。     

应用蛋白质印迹技术检测特异性癌胚抗原在胃癌诊断中的价值

癌胚抗原(CEA)作为肿瘤标志物已广泛用于临床恶性肿瘤的诊断，尤其对消化道肿瘤的诊断。然而临床应用也发现许多不足之处，主要为存在假阳性、假阴性及特异性不强的问题，表现在一些良性疾病时CEA也升高．这局限了CEA诊断恶性肿瘤的特异性Ⅲ。造成这种情况的主要原因是由于CEA相关物质影响所致。CEA家族包含多种物质，除恶性肿瘤时产生分子量为208341u的特异性CEA外，     

经内镜逆行胆胰管成像联合血清标志物对胆道良恶性肿瘤的诊断价值

目的探讨经内镜逆行胆胰管成像(ERCP)联合血清标志物对胆道良恶性肿瘤的诊断价值。方法选取2020年3月至2022年3月南阳医学高等专科学校第一附属医院收治的159例疑似胆道恶性肿瘤患者作为研究对象, 所有患者经手术和病理证实为胆道恶性肿瘤的患者75例, 胆道良性肿瘤患者35例, 其他胆道疾病患者49例。采用糖类抗原CA19-9(CA19-9)、癌胚抗原(CEA)电化学发光法检测试剂盒检测所有患者血清CA19-9、CEA水平。比较ERCP检查在胆道良恶性肿瘤中的诊断价值。比较ERCP联合血清标志物CA19-9、CEA在胆道良恶性肿瘤的检出率。组间比较采用t检验。结果胆道恶性肿瘤患者血清中CA19-9和CEA水平[(229.04±129.01) U/ml、(23.34±14.47) ng/ml]明显高于胆道良性肿瘤患者[(83.19±47.42) U/ml、(5.90±1.75) ng/ml]和其他胆道疾病患者[(23.51±9.41) U/ml、(3.34±1.28) ng/ml], 差异有统计学意义(t=6.474, P<0.05;t=11.12, P<0.05;t=7....     

胆汁CA19—9检测对胆道癌诊断价值的探讨

目的 探讨胆汁ＣＡ１９－９在胆道良恶性病变的诊断价值。方法 本研究选择手术及病理证实的胆道恶性肿瘤２６例，胆道良性病变９２例，正常健康人１３例，采用ＲＩＡ同时联合检测胆汁ＣＡ１９－９、ＣＥＡ，进行定量分析。结果ＣＡ１９－９的含量分界值为１２０００ｕ／ｍｌ，其敏感性，特异性分别为９２．３１％，７２．８３％；胆汁ＣＥＡ水平分界值为４９０ｎｇ／ｍｌ，其相应指标分别为５７．６９％、７８．２６％。胆汁ＣＡ１     

胆汁癌胚抗原的检测与结肠癌肝转移的关系初探

目的　探讨胆汁癌胚抗原(CEA)的检测对结肠癌肝转移的诊断价值,为早期诊断转移癌提供一新的思路。方法　81例患者分为3组:A组2 6例,为非肿瘤行腹腔手术治疗患者;B组45例,为结肠癌患者;C组10例,为结肠癌合并肝转移患者。所有患者均手术前空腹抽取前臂静脉血,同时术中作胆囊穿刺抽取胆汁,测定CEA值。对B组中的45例患者术后中位随访19个月。结果　(1)A、B和C组血清CEA值分别为(3 .1±0 .6)ng/ml、(10 .9±2 .2 )ng/ml、(14 .5±3 .2 )ng/ml;胆汁CEA值分别为(2 4.7±6.5 )ng/ml、(13 6.5±3 8.0 )ng/ml、(875 .0±2 13 .0 )ng/ml。B .C两组胆汁CEA值相比较差异有显著性(P <0 .0 1)。(2 )B组患者分别在3个月、6个月、9个月、12个月、18个月回院复查,作B超及CT检查,直至发现肝脏转移灶。结果发现胆汁CEA值的变化在术后肝转移出现之前,数值的高低与转移出现时间的早晚有明显的相关性,可提示肝脏病变从微小转移灶向可察见的占位转移发展的动态变化趋势。结论　胆汁CEA的检测对结肠癌肝转移的临床诊断有重要意义,其CEA值能比临床症状提前6～18个月提示肿瘤的复发或转移。检测胆汁CEA对诊断和预测结肠癌肝转移有重要临床价值。     

血清CA125、CEA联合TAM检测用于妇科肿瘤诊断的临床价值

目的探讨血清糖类抗原125(CAl25)、癌胚抗原(CEA)联合血清肿瘤相关物质(TAM)检测用于妇科肿瘤诊断的临床价值。方法选取2018-12-2019-11间在郑州大学第一附属医院接受手术治疗的184例妇科肿瘤患者,术前均检测血清CA125、CEA及TAM水平。以术后病理学诊断为"金标准",分为恶性组(46例)和良性组(138例)。统计分析血清CAl25、CEA联合TAM检测用于妇科肿瘤诊断的临床价值。结果 (1)恶性组血清CAl25、CEA及TAM水平均高于良性组,差异有统计学意义(P<0.05)。(2)将CAl25>35 U/mL、CEA>5.2 ng/mL、TAM>95 U/mL作为临界值,三项联合检测的敏感度、特异性、准确率均明显高于单项检测,差异有统计学意义(P<0.05)。结论血清CAl25、CEA联合TAM检测可提高妇科良恶性肿瘤的诊断和鉴别诊断效果。     

胆管癌患者胆汁中肿瘤标志物测定及其临床意义

目的探讨胆汁中肿瘤标志物对胆管癌的诊断价值。方法采用放射免疫测定法测定31例胆管癌患者和13例良性胆管疾病患者的胆汁中癌胚抗原（CEA）、甲胎球蛋白（AFP）、糖链抗原（CA19-9）的含量;确定具有诊断价值的肿瘤标志物及其分界值。结果良恶性组胆汁中AFP、CA19-9水平差异无显著性（P> 0.05）;恶性组胆汁CEA水平高于良性组（P< 0.05）。取分界值为7.0ng/ml,根据胆汁CEA水平升高诊断胆管癌的敏感性为80.6%,特异性为100％。结论胆汁中CEA水平增高是诊断胆管癌的一个重要指标。     

Role of carcinoembryonic antigen, carbohydrate antigen 19-9 and cytology of bile in diagnosis of biliary and pancreatic cancer

To evaluate the clinical value in diagnosis of biliary and pancreatic cancer carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9) and cytology in the bile were examined in 343 patients with benign biliary disease and 71 patients with biliary and pancreatic cancer. An abnormal CEA level was defined as a level of more than 500 ng/ml in the gallbladder bile and 40 ng/ml in the bile duct bile. Increased bile CEA levels were observed in 50.0% in 22 patients with bile duct cancer, 60.0% in 20 with gallbladder cancer and 23.8% in 21 with pancreas cancer. False positive rate in 343 patients with benign diseases was only 1.2%. Bile CA19-9 levels were measured in 195 patients with benign disease and 30 with malignancy. However, the overlap between the values of the 2 groups was too great for differentiation of malignancy from benign disease. The positive rates of bile cytology were 52.2% in 23 patients with bile duct cancer, 40.0% in 15 with gallbladder cancer and 27.3% in 22 with pancreatic cancer. The diagnostic accuracies of combined assessment of bile CEA and cytology were 68.0% in 25 patients with bile duct cancer, 77.3% in 22 with gallbladder cancer and 37.5% in 24 with pancreatic cancer. The sensitivity of this combined test was 60.6% (43/71), and the specificity was 98.8% (339/343). This combined test is considered to be reliable screening test especially for biliary cancer.     

Biliary carcinoembryonic antigen, non-specific cross-reacting antigen and biliary glycoprotein--their analysis and clinical aspects

Bile sample were collected in 17 cases of choledocholithiasis, 28 of malignant obstructive jaundice and 7 of hepatolithiasis and biliary CEA levels were measured by the EIA method. In the malignant obstructive jaundice group, the biliary CEA level was higher than that in the choledocholithiasis group and the bile gave a positive test for CEA more frequently than the serum. As for the hepatolithiasis group, the biliary CEA level was higher than that in the malignant obstructive jaundice group. The EIA method, however, had a possibility that not only CEA but also CEA-related antigens were measured. Therefore, antigen for CEA, NCA and BGP were prepared, and biliary CEA, NCA and BGP levels were measured by the ELISA method. The biliary CEA level (mean +/- S.D.) was 0.086 +/- 0.26 for 21 cases of cholelithiasis, 0.119 +/- 0.24 for 15 of pancreatic carcinoma, and 0.117 +/- 0.016 for 17 cholangiocarcinoma, cholecystic carcinoma, being thus significantly (p less than 0.05) higher in malignant disease. In malignant disease, both biliary NCA and biliary BGP increased, though not so remarkable compared with CEA. Even in controls, the biliary NCA and BGP levels were not negligible.     

Can Biliary Carcinoembryonic Antigen Identify Colorectal Cancer Patients with Occult Hepatic Metastases?

Background Twenty-five percent of radically treated colorectal cancer patients already have occult hepatic metastases (OHM) that will later be observed during postoperative follow-up. Instrumental examinations, i.e., intraoperative ultrasound or Doppler perfusion index, have not improved diagnosis. As carcinoembyonic antigen (CEA) levels are useful to reveal hepatic metastases from colorectal cancer, determination of CEA in the bile rather than the blood may allow preclinical diagnosis of OHM thanks to the reduced volume of bile. Methods One hundred radically treated colorectal cancer patients were enrolled in the study. Bile was withdrawn from the gallbladder intraoperatively and biliary CEA levels determined using an immuno-enzymatic method (normal value 0–5 ng/ml). Eighty-nine fully evaluable patients were followed up for three years postoperatively to monitor hepatic metastases. Preoperative blood CEA, lymph node metastases and biliary CEA were compared in order to assess which procedure was more efficient in identifying patients who would develop hepatic metastases. Results Eleven of the 89 evaluable patients developed hepatic metastases: 9/11 presented elevated biliary CEA levels (mean: 12.73; range: 5.1–26.2); 8/11 had high preoperative blood CEA values; and 9/11 were at anatomopathological stage N+. In the 78 patients who did not develop hepatic metastases, biliary CEA was within normal limits in 73/78, preoperative blood CEA was normal in 60/78, and 58/78 patients were at anatomopathological stage N−. Hence, the sensitivity of biliary CEA was 81.8%, specificity was 93.6%, and diagnostic accuracy was 92.1%. Conclusions Determination of biliary CEA seems to be more efficient in identifying patients presenting OHM who require frequent clinical examinations or adjuvant cancer treatment.     

胆道肿瘤的潜在标志物Mrp14

目的 探讨胆道肿瘤特异性的标志物,为胆道肿瘤的早期诊断、判断预后、监测复发以及治疗等提供帮助,同时为进一步研究胆道肿瘤的发病机制提供线索。方法 收集经病理结果证实的胆道癌和胆囊癌患者的组织、胆汁标本以及良件胆道和胆囊疾病患者的组织、胆汁标本,应用双向电泳和MALDI-TOF-MS质谱技术检测出恶性和良性组织、恶性和良性病变患者胆汁之间差异表达的蛋白。对同时高表达于胆道癌、胆囊癌及恶性病变胆汁的蛋白Mrp14进行Western blot、免疫组化验证,RT-PCR监测基因表达水平。结果3组蛋白标本双向电泳后质谱成功鉴定出30个差异表达的蛋白,其中Mrp14同时在胆道癌、胆囊癌及恶性病变胆汁中高表达。Western blot、免疫组化及RT-PCR验证其在蛋白和基因水平于恶性组织中高表达。结论 Mrp14在胆道系统恶变后表达增高,可能为胆道肿瘤发生、发展的候选肿瘤标志物。     

Identification of carcinoembryonic antigen (CEA) in bile of patients with malignant biliary tract disease

As a diagnostant of malignant hepato-biliary tract disease, carcinoembryonic antigen (CEA) levels in the bile and serum were evaluated in 12 patients with benign and 19 patients with malignant hepato-biliary diseases. Of the 12 patients with benign disease, 3 had a residual choledocholithiasis. CEA levels were determined in 7 patients with cancer of the head of pancreas or of the duodenal ampulla. Bile samples were obtainedvia biliary tract drainage after allowing for sufficient time to exclude the effects of pre-existing bile stasis or inflammation. The average serum CEA levels from 8 patients with benign disease were 1.5±0.23 ng/ml in contrast to 3.3±0.55 ng/ml in 18 with a malignancy (p<0.05). The average CEA levels in bile from 9 patients with benign and 19 with a malignancy were 1.7±0.31 ng/ml and 7.6±1.70 ng/ml respectively (p<0.01). In 3 with residual choledocholithasis, serum and bile CEA levels were 2.0±0.46 ng/ml and 13.1±6.47 ng/ml. The serum and bile CEA levels from 7 patients with cancer of the head of the pancreas or of duodenal ampulla were 2.5±0.32 ng/ml and 8.8±3.3 ng/ml, respectively. Although measurement of both serum and bile CEA levels in patients with hepato-biliary tract disease proved to be useful for differentiation of malignant from benign disease, the high value obtained strongly suggests the presence of a malignancy in addition to the residual choledocholithiasis and cancer of the head of the pancreas or of the duodenal ampulla.     

High serum concentrations of sialyl Tn antigen in carcinomas of the biliary tract and pancreas

Sialyl-Tn (STn) antigen is a cancer-associated carbohydrate antigen expressed in cancers of the digestive tract. In the present study, we compared the serum level of STn antigen in 14 patients with benign diseases of the biliary tract and pancreas, 15 patients with bile duct cancers, and 9 patients with cancer of the pancreas. High levels of serum STn (>45 U/ml) were frequently detected in patients with carcinoma of the biliary tract (53.3%) or pancreas (55.6%), compared with the detection of high levels in those with benign diseases (14.3%; P < 0.05). Serum levels of STn did not correlate with the presence of jaundice, cholangitis, or pancreatitis, or with the level of carcinoembryonic antigen (CEA) or carbohydrate antigen (CA) 19-9. In cancer tissues, the expression of STn antigen detected by immunostaining correlated significantly with serum STn (P < 0.05). Our results indicate that measurement of serum STn level may be potentially useful for the diagnosis of carcinomas of the biliary tract and pancreas, particularly when combined with other tumor markers such as CEA or CA19-9. Received for publication on Nov. 19, 1998; accepted on Jan. 4, 1999