【作者】 林哲洙； 金锋；

【机构】 中国医科大学附属第一医院肿瘤外科；

【摘要】 目的:探讨C—12型蛋白芯片检测系统中10种肿瘤标志物在胃肠癌、乳腺癌患者血清中的表达情况,并筛选出临床诊断价值较高的标志物。方法:1．采用C-12型多肿瘤标志物蛋白芯片检测系统测定28例胃癌、22例大肠癌、32 例乳腺癌、28例良性肿瘤患者和19例健康对照者血清中10 种肿瘤标志物(CA19-9,NSE、CEA、CA242、CA125、 CA15-3、AFP、Ferritin、HCG、HGH)的表达水平。2．使用SPSS12．0软件包进行统计分析。计量资料用中位数(Md) 和四分位数间距(IQR)表示。各组计量资料行Mann- Whitney U检验。计数资料用x2检验比较。P<0．05具有统计学意义。结果:1．胃肠癌组CEA检测水平显著高于对照组 (P<0．01)。2．所检测的10种标志物单项对胃癌的敏感性依次为CEA(28．6％)>CA19-9(21．4％)>CA242(14．3％)、AFP (14．3％)>Ferritin(10．7％)>NSE(3．6％)、CA125(3．6％)、 HCG(3．6％)、HGH(3．6％)>CA15-3(0％)。多肿瘤标志物联合检测明显提高胃癌诊断效率,将敏感性、特异性和阳性预测值三项指标综合评价比较,CEA+CA19— 9+CA242+AFP组合为诊断胃癌效率较高的组合,敏感性为 46．4％(13／28)、特异性为96．4％(27／28),阳性预测值为 92．9％(13／14),敏感性与对照组比较差异显著(P<0．001), 敏感性与CA242、AFP比较也有明显差异(P<0．05)。CEA、 CA19-9、CA242、AFP随胃癌病情进展程度出现敏感性升高趋势,但没有统计学差异。3．所检测的10种标志物单项对大肠癌的敏感性依次为CEA(45．5％)>CA19-9(22．7％)、 CA242(22．7％)>Ferritin(9．1％)、CA125(9．1％)>NSE (4．5％)、HCG(4．5％)>AFP(0％)、HGH(0％)、CA15-3 (0％)。CEA+CA19-9+CA125组合为诊断效率较高的组合。敏感性为50．0％(11／22)、特异性为96．4％(27／28)、阳性预测值为91．7％(11／12),其中敏感性与对照组比较差异显著(P<0．001),与CA125比较也有显著差异(P<0．01)。CEA、 CA19-9和CA242敏感性随着大肠癌病情进展程度出现明显升高趋势。4．所检测的10种标志物单项对乳腺癌的敏感性依次为Ferritin(12．5％)>CA242(6．25％)、HGH(6．25％)>CEA (3．13％)、CA19-9(3．13％)、CA15-3(3．13％)>CA12(0％)、 AFP(0％)、NSE(0％)、HCG(0％)。相对而言 CA153+CA242+HGH组合为诊断乳腺癌效率较高的组合。敏感性为15．6％(5／32)、特异性为92．9％(26／28)、阳性预测值为71．4％(5／7);CA242检测水平在乳腺癌ER、PR 阳性患者明显高于阴性患者(P<0．05);CA15-3检测水平在ER阳性患者明显高于阴性患者(P<0．05)。结论:通过采用多肿瘤标志物蛋白芯片检测系统中10种常用标记物 CEA、CA19-9、CA242、AFP、Ferritin、NSE、CA125、 HCG、HGH、CA15-3对胃肠癌、乳腺癌进行联合检测比较,CEA+CA19-9+CA242+AFP组合为胃癌、 CEA+CA19-9+CA125组合为大肠癌的临床诊断提供了较高的可信度及临床应用价值;相反,对于乳腺癌则不具有足够的临床应用价值。更多还原

【Abstract】 Objective: To investigate the expression of Protein-chip System for ten tumor markers in the serum of gastric cancer(GC), colorectal cancer(CRC) and breast cancer(BC) patients, then filtrate the more valuable markers for clinical diagnosis. Methods: 1.The serum levels of tumor markers(CA19-9, NSE, CEA, CA242, CA125, CA15-3, AFP, Ferritin, HCG, HGH) were measured by using the protein-chip system in 28 GC patients, 22 CRC patients, 32 BC patients, 28 carcinoid patients and 19 cases of normal people.The process according to the manufacture’ s commend by using C - 12 Protein-chip System reagent kit for diagnosis,and record the results by using the corresponding apparatus (H D - 2001 A). 2.Sta-tistics analysis:SPSS12.0 for windows was used.The datas are presented by deviation median) Md) and inter-quartile range(IQR).The Mann-Whitney U test was used for enumeration data ,and the chi-square test was used to evaluate the difference for count data. P<0.05 was thought to be the statistical significance. Results: 1. The serum level of CEA in the GC and CRC patients was much higher than the control group. 2. The sensitivities of 10 tumor markers in the GC patients were described by descending order: CEA 28.6, CAI9-9 21.4%, CA242 14.3%, AFP14.3%, Ferritin 10.7%, NSE 3.6%, CA12S 3.6%, HCG3.6%, HGH 3.6% and CA153 0%.Thought about the combination of sensitivit, specificity and positive predictive value(PV+), CEA+CA19-9+CA242+AFP was the better one,for its sensitivity was 46.4% (13/28, specificity was 96.4%(27/ 28), positive predictive value (PV+) was92.9%(13/14), the difference compared with the control group had the statistical significance( P<0.001 ). The sensitivity of the CEA, CA19-9, CA242, AFP parameters showed a trend that those rise went along with the progress. 3. The sensitivities of the markers in the CRC patients were described by descending order: CEA 45.5%, CA19-9 22.7%, CA242 22.7 %, Ferritin 9.1 %, CA125 3.6%, NSE 3.6%, HCG3.6%, AFP14.3%, HGH 3.6% and CA153 0%. CEA+CA19-9+CA125 was the better one for the CRC diagnosis,for its sensitivity was50.0% (11/22 ), specificity was96.4% ( 27/ 28), positive predictive value(PV+) was 91.7%(11/12 ). The sensitivity of the CA19-9, CEA, CA242 parameters showed a trend that those rise along with the progress of CRC. 4. The sensitivity of the markers were Ferritin 12.5%, CA242 6.25%, HGH 6.25%, CEA 3.13 %, CA19-9 3.13%, CA153 3.13%, CA125 0%, AFP 0%, NSE 0%, HCG 0% in the BC. The combination of CA153+CA242+HGH was the better one for the BC diagnosis relatively, for its sensitivity was12.5 %(4/32), specificity was 85.7% ( 24/28 ), positive predictive value(PV+) was 57.1 %(4/7 ). The serum level of CA242 in the BC patients both the ER and PR positive were higher than the negative ones( P<0.05 ).And the level of CA15-3 in the ER positive BC patients was higher than the negative ones( P <0.05 ). Conclusion: On the condition that filtrated the markers including CEA, CA19-9, CA242, AFP, Ferritin, NSE, CA125,更多还原