联合检测肿瘤标志物在消化道恶性肿瘤中的应用研究

目的寻找一种有价值的高敏感、高特异性的肿瘤标志物联合检测方法，提高消化道恶性肿瘤的诊断率。方法选择136例消化道恶性肿瘤患者作为观察组，包括结肠癌、胃癌、胰腺癌、肝癌、胆管癌，均经影像学及病理检查确诊；另选择健康体检者52例作为对照组。使用电化学发光免疫法检测2组糖类抗原（CA19—9）、黏蛋白分子CA72—4、高分子糖蛋白CA50、甲胎蛋白（AFP）及癌胚抗原（CEA），比较2组检测结果。结果CA19—9对胆管癌以及胰腺癌敏感度较高，AFP则对肝癌敏感性高，CA72—4对胃癌敏感度高；对于部分消化道肿瘤，肿瘤标志物单项检测有效性以及灵敏度与联合检测相比较均显著降低（P均〈0．05），但部分联合检测的特异性有一定下降。对于胰腺癌、胆管癌以及结肠癌，CEA联合CA19—9、CA50为首选检测标志物；对于胃癌，CEA联合CA19—9、CA72—4可作为首选标志物；对于肝癌，CEA联合AFP是首选标志物。胰腺癌及结肠癌术后几种标志物水平均有下降，术后1．5个月CEA与CA19—9恢复趋于正常、结论对于消化道恶性肿瘤，选择互补性较强且有价值的肿瘤标志物十分重要，可做到早发现、早诊断及早治疗，有着较重要的临床价值和应用意义。

Study of application on combined detection of tumor markers in malignant tumors of digestive tract

Objective It is to search a valuable combined detection methods on tumor markers with high sensitivity and specificity, so as to increase the diagnostic rate of malignant tumor of digestive tract. Methods 136 patients with malignant tumor of digestive tract were selected as observation group, including colon cancer, gastric cancer, pancreatic, cancer, liver cancer, cholangiocarcinoma, all cases were confirmed by imaging and pathology; and 52 healthy subjects were chose as control group. The electrochemiluminescence immunoassay method was using in both groups tot detection of the project, including carbohydrate antigen （CA19 -9） , mucin CA72 -4, macromolecule glycoprotein CA50, alpha fetoprotein （AFP） and careinoembryouic antigen （CEA） , then the result was compared. Results CA19 -9 was more sensitive to cholangiocarcinoma and pancreatic cancer, AFP had high sensitivity on liver cancer, CA72 -4 had high sensitivity on gastric caneer. For some tumors of digestive tract, the validity and sensitivity of single tumor marker detection were markedly lower than that of combined detection （all P 〈 0.05 ） however, the specificity was decreased in part of combined detection. CEA combined with CA19 -9 and CA50 was the preferred marker for pancreatic cancer, bile duct cancer and colon cancer, CEA combined with CA19 - 9 and CA72 -4 could be used as the preferred markers for gastric cancer, AFP combined with CEA was the preferred marker for hepatocellular carcinoma. After the surgery of pancreatic cancer and colon cancer, several markers were decreased; CEA and CA19 -9 were recovered to normal in 1.5 months after operation. Conclusion For malignant tumor of digestive tract, the selection of complementary tumor marker of strong and valuable is very important, it can achieve early discovery, early diagnosis and early treatment; there is important clinical worth and application significance.