多项肿瘤标志物联合检测在胃肠道肿瘤诊断中的价值

目的探讨血清癌胚抗原(carcino-embryonic antigen,CEA)、CA19-9、CA72-4、胃蛋白酶原(pepsinogen,PG)联合检测在胃肠道肿瘤诊断中的价值。方法以2015年6月至2018年12月在中山大学附属第一医院东院收治的54例胃癌、110例结直肠癌住院患者为研究对象,所有患者均经过影像、胃镜、肠镜或组织病理学确诊,以同期健康体检非肿瘤人群53例作为健康对照组,同期收治的281例非胃癌、结直肠癌的消化道肿瘤(包括肝癌、食道癌、胆管癌)患者作为疾病对照组。采用直接化学发光法检测血清CEA、CA19-9、PG水平,并计算PGⅠ/PGⅡ比值(PGR);采用电化学发光法检测血清CA72-4水平。使用SPSS 25.0进行数据统计处理,结果以P<0.05为差异有统计学意义。结果(1)在胃癌、结直肠癌组中,CEA、CA19-9、CA72-4的测定值明显高于健康对照组;CEA、CA72-4的测定值明显高于疾病对照组;PGⅠ在胃癌、结直肠癌中的测定值明显低于健康对照组;(2)在胃癌组中,PGR的测定值与阳性率与两个对照组比较均有明显差异,PGⅡ的测定值则与两个对照组比较差异均无统计学意义;在结直肠癌组中,PGⅠ、PGⅡ的测定值与健康对照组比较差异有统计学意义,PGR的测定值与阳性率与两个对照组比较差异均无统计学意义。(3)血清肿瘤标志物单项检测对胃肠道肿瘤检测灵敏度不高,但PGR对于胃癌诊断特异性达95%,可作为阴性排除的依据。(4)肿瘤标志物联合检测对胃癌、结直肠癌检测的灵敏度均明显增高,特异性有所下降。其中以四项肿瘤标志物联合检测对胃肠道肿瘤诊断效能较好,ROC曲线下面积均达0.8。结论CEA、CA19-9、CA72-4、PG是诊断胃癌、结直肠癌的可靠指标;CEA、CA19-9、CA72-4、PG联合检测对胃肠道肿瘤的早期辅助诊断有意义,且能明显提高检出率。

The Diagnostic Value of Combining Multiple Tumor Markers in Gastrointestinal Tumors

Objective To explore the value of combining tumor markers of carcinoembryonic antigen(CEA)and carbohydrate antigens CA19-9,CA72-4,pepsinogen(PG)in gastroenteric tumor diagnosis.Methods 54 cases of gastric cancer patients and 110 cases of colorectal cancer patients hospitalized in the East Division of the First Affiliated Hospital,Sun Yat-sen University from June,2015 to December,2018 were included for the study.All patients were diagnosed by iconography,gastroscopy,colonoscopy or histopathology.53 cases of healthy individuals without gastroenteric tumor at the same period were selected as the healthy control group,and 281 non-gastric cancer and colorectal cancer digestive tract tumors(including liver cancer,esophageal cancer and cholangiocarcinoma)were enrolled as the disease control groups.Serum CEA,CA125,CA19-9 and Pepsinogen levels were detected by direct chemiluminescence and serum CA72-4 level was detected by electrochemical luminescence.Statistical software SPSS 25.0 was used for data analysis and P<0.05 was considered statistically significant.Results(1)In the group of gastric cancer and colorectal cancer,CEA,CA19-9 and CA72-4 were significantly higher than that in the healthy control group,also CEA and CA72-4 was significantly higher than that in the disease control group.PG I was significantly lower than that in the healthy control group.(2)In the gastric cancer group,PGR value and its positive rate were significantly different from those of the control groups,while PG II was not significantly different from the two control groups.In the colorectal cancer group,the levels of PG I and PG II had obvious differences compared with healthy controls,while PGR level and its positive rate had no statistical significance compared with the two control groups.(3)The sensitivity of single serum tumor marker test in gastrointestinal tumor was not high,but the specificity of PGR for the diagnosis of gastric cancer was 95%,which could be used as auxiliary indicator to exclude diagnosis.(4)The sensitivity of joint detection of tumor markers for gastric cancer and colorectal cancer were significantly increased,and had a good diagnostic efficacy for gastrointestinal tumors,with the area under ROC curve reaching 0.8.Conclusion CEA,CA19-9,CA72-4 and Pepsinogen are reliable indicators for the diagnosis of gastric cancer and colorectal cancer.The combined detection of CEA,CA19-9,CA72-4 and Pepsinogen is significant for the early auxiliary diagnosis of gastrointestinal tumors and can significantly improve the detection rate.