异常凝血酶原联合CEA、CA72-4和CA199在胃癌诊治中的价值

目的 拟评估异常凝血酶原（PIVKA-Ⅱ）联合CEA、CA199和CA72-4在胃癌的诊断、治疗及复发转移监测中的应用价值。方法 化学发光法检测123例胃癌患者、80名健康对照者以及30例胃良性疾病患者血清中的PIVKA-Ⅱ水平及CEA、CA199、CA72-4水平，并对其中20例胃癌患者进行随访检测。结果 胃癌患者血清PIVKA-Ⅱ水平明显高于胃部良性疾病患者和健康对照者（均P<0.001）。ROC曲线分析，PIVKA-Ⅱ检测胃癌的临界值为32.14 U/L、敏感度为39.84%、特异性为95%，相比于CEA、CA199、CA72-4的检测，敏感度未有显著提高，特异性稍低。胃癌患者血清PIVKA-Ⅱ水平及阳性率随着肿瘤分期的升高而升高（均P<0.05）。进行有效治疗的20例进展期胃癌患者PIVKA-Ⅱ水平下降。四项组合诊断胃癌的敏感度和有效性最高。结论 PIVKA-Ⅱ联合CEA、CA199、CA72-4检测在胃癌的诊断、疗效及监测复发转移中，具有一定的临床价值。

Clinical Value of Abnormal Prothrombin Combined with CEA,CA72-4 and CA199 on Patients with Gastric Cancer

Objective To evaluate the clinical value of abnormal prothrombin (PIVKA-Ⅱ) combined with CEA, CA199 and CA72-4 on the diagnosis, treatment, recurrence and metastasis of patients with gastric cancer. Methods Serum PIVKA-Ⅱ, CEA, CA72-4, CA199 levels in 123 gastric cancer patients, 80 healthy controls and 30 benign gastric diseases patients were performed by chemiluminescent immunoassay(CLIA), electrochemiluminescence immunoassay (ECLIA), respectively. And random 20 patients with gastric cancer were followed up. Results The level of PIVKA-Ⅱ was significantly higher in gastric cancer group than those in benign gastric disease group and healthy control group (all P<0.001). ROC analysis showed the cutoff value to discriminate cancer from control was established at 32.14U/L for PIVKA-Ⅱ (sensitivity (39.84%), specificity (95%)). The sensitivity of PIVKA-Ⅱ was not significantly higher than CEA, CA199 or CA72-4, while the specificity was slightly lower. With the rising of gastric carcinoma stage, the levels of PIVKA-Ⅱ as well as the positive rate were increased (all P<0.05). Elevated levels of PIVKA-Ⅱ were found in the recurrent or metastasis disease patients, and the levels were decreased in 20 patients who were sensitive to therapy. The sensitivity and effectiveness of the group of four tumor markers were the highest in all combination groups. Conclusion There is specifically clinical application value of PIVKA-Ⅱ, CEA, CA199 and CA72-4 in the diagnosis, curative effect and prognosis monitoring of gastric cancer.