【作者】 陈军；

【导师】 徐越超；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 由于环境污染、人口老龄化、遗传因素、缺乏锻炼等不良习惯导致癌症人数不断增加。世界卫生组织预计2020年全世界癌症发病率将比现在增加50％，其中消化道肿瘤占重要部分。我国消化道肿瘤发病率也呈上升趋势，病死率在癌症中居首位。与此同时，随着近年来医学诊疗技术的发展，胃肠道肿瘤的诊疗手段也日新月异，新的诊断、治疗方法层出不穷，目前常用的诊断方法有病理学检查、影像学检查、内镜检查、血清生化指标检测等。其中血清肿瘤标志物检测作为临床最方便常用的检测方法，已广泛应用于临床肿瘤的辅助诊断、疗效观察和判断预后以及监测病情。然而，目前作为肿瘤标志物的肿瘤抗原多为非特异性相关抗原，单项指标检测，敏感度较低，存在较大漏诊率，特异度较差，需要借助其他辅助诊断，因此在肿瘤的筛查和早期诊断中有一定的局限性。因此，对肿瘤标志物的联合检测对临床诊断非常必要，同时联合检测可以提高肿瘤诊断的敏感性及特异性从而在一定程度上弥补单项检测的缺陷，同样对消化道肿瘤早期诊断及术后病情监测有着重要价值。CA72-4作为胃肠道肿瘤的标志物,对胃、结直肠癌有高度特异性，85%~95%的胃、结肠的肿瘤患者中可以检测出CA72-4升高,良性肿瘤、渗出物或正常人组织内检测不出CA72-4。据相关报道证实，CA72-4对胃肠道肿瘤的敏感性为78.8%，是诊断胃癌、结直肠癌的一个可靠标志物。CA125抗原可被OC125抗体识别。这种抗原在多种肿瘤，如胃癌、乳腺癌、肝癌、胰腺癌、结肠癌、肺癌、子宫内膜癌等肿瘤中均有不同程度的表达。在胎儿的羊膜和由体腔上皮细胞衍生的组织中，以及在成人输卵管上皮、子宫内膜和子宫颈内膜都可发现CA125抗原。 CA125血清浓度在某些良性疾患中也会有所提高，如一些良性妇科疾患、早期妊娠、急性或慢性胰腺炎、慢性肝炎、非恶性肠胃道疾病、消化道恶性肿瘤、肾功能不全、自身免疫病等疾病。由此可见，CA125特异性较低。CA19-9亦称胃肠癌相关抗原，CA19-9亦称消化道肿瘤相关抗原，是一种腺癌的抗原物质，在腺癌细胞中产生，通过胸导管引流到血循环中，从而使CA19-9水平在外周血中升高，其在消化道内的含量最高。当胃结直肠癌伴肝转移转移时CA19-9增高尤为显著，高于其他肿瘤标志物。CA199对消化系统恶性肿瘤诊断优于其他肿瘤标志物。CEA作为最常见的肿瘤标记物之一，被广泛用于各种消化系统肿瘤的诊断及监测。CEA是从结肠癌和胚胎组织中提取的一种肿瘤相关抗原，它属于肿瘤细胞表面的结构抗原，在细胞质中形成，通过细胞膜进入周围体液中，可以在多种体液中检出。本研究共选择646例对象，其中胃癌组214例，结直肠癌354例，胃间质瘤25例，对照组53例。探讨血清肿瘤标志物的应用方法，并通过分析血清肿瘤标志物在胃结直肠癌患者中的水平，对检测结果进行统计学处理，探讨其在诊断胃癌、结直肠癌和判断胃结直肠癌患者预后中的应用。更多还原

【Abstract】 Because of the pollution of the environment, the aging of the population,genetic factors, lack of exercise and other bad habits lead to the increasingnumber of cancer. Who is expected to2020the whole world cancer incidencethan is now increased to50%, which was an important part of digestive tracttumor. China’s digestive tract tumor incidence rates are on the rise, the fatalityrate in cancer ranks first in. At the same time, as in recent years thedevelopment of medical technology, the means of diagnosis and treatment ofgastrointestinal tumor also change rapidly, new diagnostic, therapeutic methodsemerge in an endless stream, commonly used diagnostic method forpathological examination, imaging examination, endoscopy, serum biochemicalindex test.The serum tumor markers for detection of clinically as the mostconvenient common detection method, has been widely used in clinical tumordiagnosis, curative effect observation and judgment of prognosis andmonitoring of disease. However, at present as a tumor marker tumor antigensare nonspecific antigen detection, single index, sensitivity is low, there is a bigrate of misdiagnosis, specificity is poor, need the help of other auxiliarydiagnosis, therefore in the screening and early diagnosis of tumors have certainlimitations. Therefore, the combined detection of tumor markers for the clinicaldiagnosis is very important, at the same time can improve the diagnosis ofcombined detection of tumor sensitivity and specificity to a certain extent so asto compensate for the individual to detect defects, similarly to the digestivetract tumor early diagnosis and postoperative surveillance of patients has important value.To find tumor-specific antigen has been the hot spots of cancer research,and serum tumor markers in the early days of high hopes, hopes that it will playan important role in the diagnosis and treatment of tumors.CA72-4as a gastrointestinal tumor markers for gastric, colorectal cancer,there is a high degree of specificity,85%~95%of the stomach, colon cancerpatients can detect CA72-4elevated, benign tumor, exudate or normal tissuedetect CA72-4. According to reports confirmed, CA72-4in gastrointestinaltumor sensitivity to78.8%for diagnosis of gastric cancer, colorectal cancer, is areliable marker. CA125antigen by OC125antibody recognition. This antigen ina variety of tumors, such as breast cancer, gastric cancer, liver cancer,pancreatic cancer, colon cancer, lung cancer, endometrial cancer and othertumors of different degrees of expression. In fetal amniotic membrane and fromcoelomic epithelium derived tissues, as well as in the adult oviductal epitheliumof the endometrium and cervix, endometrium can be found in the CA125antigen. Serum CA125concentrations in some benign diseases also will beimproved, such as the number of benign gynecological diseases, earlypregnancy, acute or chronic pancreatitis, chronic hepatitis, non malignantgastrointestinal diseases, malignant tumors of digestive tract, renalinsufficiency, autoimmune disease. Thus, CA125lower specificity. CA19-9alsoknown as gastric cancer associated antigen CA19-9, also known asgastrointestinal tumor associated antigen, is a kind of adenocarcinoma of theantigenic substance, in cancer cells, via the thoracic duct drainage into theblood circulation, so that the CA19-9levels in peripheral blood in elevation, thehighest content in the digestive tract of. When the gastric colorectal cancer withliver metastasis when CA19-9increased significantly, higher than that of othertumor markers. CA199diagnosis of malignant tumor of digestive system issuperior to other tumor markers. CEA as the most common tumor markers, are widely used in all kinds of digestive system tumor diagnosis and monitoring.CEA is from colon and embryonic tissues extracted a tumor-associated antigen,it belongs to the tumor cell surface antigens in the cytoplasm of the structure,form, through the cell membrane into the surrounding body fluids, can be in avariety of body fluid detection.This research selected646cases of gastric cancer, which group of214cases,354cases of colorectal cancer, gastric stromal tumor in25cases,53casesof the control group. Discussion on the application of serum tumor markers,and through the analysis of serum tumor markers in gastric and colorectalcancer patients in level, the detecting results are statistically processed, exploreits in the diagnosis of gastric cancer, colorectal cancer and gastric prognosis incolorectal cancer patients application.更多还原