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目的评价CEA,CA19-9及CA242联合检测对大肠癌患者的临床诊断价值。方法应用酶联免疫法对150例术前大肠癌患者及其中70例术后患者和200名健康人血清CEA,CA19-9及CA242含量进行测定。结果大肠癌患者血清3项标志物含量明显高于健康人(均P<0.01);单项和联合检测的阳性率及特异性总体比较差异均有统计学意义(均P<0.01);其中CEA、CA242检测的阳性率显著高于CA19-9;CEA+CA242与3项联合检测的阳性率均显著高于单项或其他两项联合检测的阳性率;CEA特异性高于CA242;3项联合检测的特异性明显低于单项检测。3个年龄段大肠癌患者CEA血清水平差异显著,年龄越大CEA水平越高(P<0.05)。在Dukes分期中,3项标志物含量及检测的阳性率依次增高(P<0.05～0.01)。淋巴结转移患者的3项标志物含量及CA19-9,CA242的阳性率均高于无淋巴结转移的患者。3项标志物含量随肿瘤侵袭程度的增加显著增高,但在组织病理分类和肿瘤大体形态中均差异无统计学意义。DukesA+B期大肠癌术后3项标志物含量显著降低(P<0.01),而C+D期改变不明显。结论3项标志物的检测有助于大肠癌的临床辅助诊断,联合检测可以提高诊断的阳性率;3项标志物检测对大肠癌临床分期、淋巴结转移及肿瘤侵犯程度评估,尤其CA19-9和CA242比用于术前诊断更有意义,对指导临床医师合理手术有一定的帮助;术后检测有助于观察疗效,评价治疗效果。
Objective To evaluate the clinical diagnostic value of combined detection of CEA, CA19-9 and CA242 in patients with colorectal cancer. Methods The serum levels of CEA, CA19-9 and CA242 in 150 patients with preoperative colorectal cancer and 70 patients with postoperative disease and 200 healthy people were measured by enzyme-linked immunosorbent assay. Results The serum levels of three markers in patients with colorectal cancer were significantly higher than those in healthy people (all P <0.01). The positive rate and the specificity of single and combined tests were significantly different (all P <0.01) The positive rate of CA242 was significantly higher than that of CA19-9. The positive rates of CEA + CA242 and 3 combined tests were significantly higher than those of the other two combined tests. The specificity of CEA was higher than that of CA242. Specificity was significantly lower than single test. The CEA serum levels of three age groups were significantly different. The older age group had higher CEA level (P <0.05). In the Dukes stage, the content of three markers and the positive rate of detection increased (P <0.05 ~ 0.01). The three markers in patients with lymph node metastasis and the positive rates of CA19-9 and CA242 were higher than those without lymph node metastasis. The content of three markers increased significantly with the degree of tumor invasion, but there was no significant difference in histopathological classification and tumor gross morphology. The levels of three markers of Dukes A + B colorectal cancer were significantly decreased (P <0.01), while the changes of C + D phase were insignificant. Conclusion The detection of three markers is helpful for the clinical diagnosis of colorectal cancer. The combined detection can improve the positive rate of diagnosis. The detection of three markers on the clinical stage, lymph node metastasis and tumor invasion of colorectal cancer, especially CA19-9 and CA242 is more meaningful than preoperative diagnosis, which can help clinicians to reasonable surgery. Postoperative examination can help to observe the curative effect and evaluate the curative effect.