血清CEA、CA199水平及其联合检测在术前诊断进展期胃癌腹膜转移中的意义

目的评价血清癌胚抗原（CEA）、糖类抗原19—9（CA199）水平及其联合检测在术前诊断进展期胃癌腹膜转移中的意义。方法对无远处转移的78例进展期胃癌患者术前作血清CEA、CA199检测，术后证实有腹膜转移者32例，无腹膜转移者46例，分析并比较有腹膜转移和无腹膜转移患者术前血清CEA、CA199的水平。结果腹膜转移组患者的血清CEA、CA199水平分别为（563±16．8）ng／ml、（165．1±108.2）ng／ml，无腹膜转移组患者分别为（16．1±6．2）ng／ml、（425±12．4）ng／ml，腹膜转移组CEA、CA199阳性率分别为50．0％、469％，无腹膜转移组分别为15±2％、17．4％，腹膜转移组明显高于无腹膜转移组（P〈0．05）：两项联合检测诊断阳性率增高达75．0％，而特异性无明显下降。结论进展期胃癌在排除远处转移的情况下如血清CEA和／或CA199升高应考虑腹膜转移的可能性。

The value of serum CEA and CA199 levels in prediction of peritoneal dissemination in advanced gastric cancer

Objective TO evaluate the significance of serum CEA and CA199 levels in prediction of peritoneal dissemination in advanced gastric cancer before operation. Methods Serum CEA and CA199 levels were measured in 78 patients with advanced gastric cancer, but no distant metastasis from January 2005 to June, 2009. Thirty two patients were confirmed with peritoneal metastasis during operation. The clinical data of all 78 patients were retrospectively analyzed. Results In patients with peritoneal dissemination the average levels of serum CEA and CA199 were higher than those in patients without peritoneal dissemination （ 56.3±16.8 ng/ml vs 16.1±6.2 ng/ml, 165.1±108.2 ng/ml vs 42.5±12.4 ng/ml, P〈0.05 ）. The positive rate of CEA and CA199 in patients with peritoneal dissemination were also higher than those in patients without peritoneal dissemination（50.0% vs 13.0%, 46.9% vs 17.4%, P〈0.05 ）. The positive rate of joint measurements increased to 75.0%; while the specificity was lowered little. Conclusion Peritoneal metastases should be considered in patients with advanced gastric cancer, when the increased serum CEA and/or CA199 levels are detected and distant metastasis is excluded.