血清CA199、CEA、CA125、CA724联合检测在胃癌诊断中的价值

目的应用Logistic回归和受试者工作特征曲线（receiver operating characteristic curve,ROC）探讨血清CA199、癌胚抗原（CEA）、CA125和CA724在诊断胃癌中的临床应用价值。方法收集258例胃癌患者、85例良性胃病患者和64例正常人的静脉血,用全自动化学发光免疫分析仪测定CA199、CEA、CA125和CA724的含量,通过Logistic回归建立回归模型,绘制ROC曲线并计算曲线下面积（area under curve,AUC）来评价各指标的诊断价值。结果胃癌组四种肿瘤标志物的水平与良性胃病组和正常对照组比较均有显著统计学差异（P〈0.01）;在胃癌/正常对照组中,四种肿瘤标志物联合检测的AUC大于各单项检测的AUC,且差异有明显的统计学意义（P〈0.01）;在胃癌/良性胃病组中,单独检测四种肿瘤标志物时,CA724的AUC（0.862）最大,且与其他三项指标单独检测的差异有明显统计学意义（P〈0.01）。CA199、CEA、CA724联合与CA199、CEA、CA125、CA724联合检测的AUC差异无统计学意义（P=0.906）,且CA199、CEA、CA724三者联合检测的AUC大于CA199、CEA、CA125或CA724任一单项检测的AUC。结论单独检测CA724对鉴别良恶性胃病具有一定的价值,而CA125在判定良恶性胃病的意义不大。CA199、CEA、CA724联合检测可为临床鉴别良恶性胃病提供有效的参考,而CA199、CEA、CA125、CA724四项联合检测的必要性不大。

Clinical value of combined detection of serum CA199,CEA,CA125 and CA724 in patients with gastric cancer

Objective To explore the diagnostic value of CA199,CEA,CA125 and CA724 for gastric cancer with lo-gistic regression and the receiver operating characteristic curve.Methods Blood samples from 258 patients with gastric cancer,85 patients with benign pancreatic diseases and 64 disease-free controls were measured by the automated chemiluminesescence immunoassay analyzer.We established regression equations,drew ROC curve and compared the area under curve to evaluate the diagnostic value of each indicator of tumors.Results The levels of serum CA199, CEA,CA125 and CA724 in patients with gastric cancer were significantly higher than other two groups （P〈0.01）.In the cancer/normal control group,the AUC of combined four tumor markers was larger than any AUC of CA199,CEA, CA125 and CA724 alone,and the differences was statistically significant（P〈0.01）.In the cancer/benign gastric disea-ses group,the AUC of CA724（0.862）was larger than AUC of CA199,CEA,CA125 alone（P〈0.01）.There was no statistically significant difference between the AUC of combined CA199,CEA,CA125,CA724 and the AUC of com-bined CA199,CEA,CA724（P=0.906）.The AUC of combined CA199,CEA,CA724 was larger than AUC of CA199, CEA,CA125,CA724 alone.Conclusion Detection of CA724 alone has a definite value in differentiating gastric cancer from benign gastric diseases,while the CA125 has slight significance.Combined detection of CA199,CEA,CA724 can provide effective reference for clinical identification of benign and malignant gastric diseases,while there was no need for detecting the combined of CA199,CEA,CA125 and CA724.