修回日期: 2006-06-26
接受日期: 2006-07-19
在线出版日期: 2006-09-08
目的: 探讨老年患者胃液中TNF-α, CA19-9和CEA联合检测对胃癌的诊断价值.
方法: 采用放射免疫技术测定42例胃癌和61例良性胃病老年患者胃液中TNF-α, CA19-9和CEA浓度.
结果: 胃癌组胃液中TNF-α, CA19-9和CEA的浓度显著高于良性胃病组(8.96±2.10 mg/L vs 4.92±1.24, 5.66±1.25 mg/L; 59.47±10.58 IU/L vs 36.89±11.23, 38.73±9.23 IU/L; 31.68±5.58 mg/L vs 17.55±3.82, 19.42±5.19 mg/L, 均P<0.001); 胃癌组联合检测胃液中TNF-α, CA19-9和CEA, 其敏感度和特异度分别97.4%, 89.3%, 均明显高于单项指标的敏感度和特异度.
结论: 联合检测胃液中TNF-α, CA19-9和CEA能有助于提高胃癌的诊断.
引文著录: 李明, 刘顺英, 李卫东, 江洁, 潘金泉, 叶正龙, 常尉文, 张文清. 探讨老年胃癌患者胃液中TNF-α, CA19-9和CEA联合检测的临床价值. 世界华人消化杂志 2006; 14(25): 2560-2562
Revised: June 26, 2006
Accepted: July 19, 2006
Published online: September 8, 2006
AIM: To explore the clinical valued of combined detection for tumor necrosis factor-α (TNF-α), carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the gastric fluid of elderly patients diagnosed with gastric cancer.
METHODS: A total of 103 patients underwent upper gastrointestinal endoscopic examination were classified as follows: gastric cancer (n = 42), superficial gastritis (n = 30), atrophy gastritis with various degrees of intestinal metaplasia or atypical hyperplasia (n = 31). The levels of TNF-α, CA19-9 and CEA in gastric fluid were examined, respectively, using immunoradiometric assay (IRMA).
RESULTS: The levels of TNF-α, CA19-9 and CEA in gastric fluid were significantly elevated in patients with gastric cancer than those in ones with benign gastric diseases (8.96 ± 2.10 mg/L vs 4.92 ± 1.24, 5.66 ± 1.25 mg/L; 59.47 ± 10.58 IU/L vs 36.89 ± 11.23, 38.73 ± 9.23 IU/L; 31.68 ± 5.58 mg/L vs 17.55 ± 3.82, 19.42 ± 5.19 mg/L, all P < 0.001). The sensitivity and specificity of combined detection for TNF-α, CA19-9 and CEA were 97.4% and 89.3%, respectively, which were markedly higher than those of any sinle index detection.
CONCLUSION: Combined detection of TNF-α, CA19-9 and CEA can improve the diagnosis of gastric cancer in the elderly patients.
- Citation: Li M, Liu SY, Li WD, Jiang J, Pan JQ, Ye ZL, Chang WW, Zhang WQ. Clinical value of combined detection of tumor necrosis factor-α, carbohydrate antigen 19-9 and carcinoembryonic antigen in gastric fluid of elderly patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2006; 14(25): 2560-2562
- URL: https://www.wjgnet.com/1009-3079/full/v14/i25/2560.htm
- DOI: https://dx.doi.org/10.11569/wcjd.v14.i25.2560
现阶段关于胃肠道肿瘤标志物联合检测报道较多, 临床价值意义评价不一. 我们尝试联合检测老年胃癌及良性胃病患者胃液中TNF-α, CA19-9, CEA的水平, 以期获得较高的敏感度、特异度和诊断准确率.
选择我院2004-01/12的门诊患者103例, 男49例(47.6%), 女54例(52.4%). 年龄60-87(69.7±6.4)岁. 其中浅表性胃炎(甲组)30例, 萎缩性胃炎伴不同程度肠化生、不典型增生(乙组)31例, 各期胃癌(丙组)42例. 均经胃镜及病理学检查确诊. GC-911型γ放射免疫计数器由科大创新股份有限公司中佳分公司提供; 125I-肿瘤坏死因子alpha (TNF-α)放射免疫分析药盒、125I-糖类抗原19-9放射免疫分析药盒、125I-癌胚抗原(CEA)放射免疫分析药盒均由北京北免东雅生物技术研究所提供. 按说明书操作, 并进行质量控制.
每例患者均在当天检查前空腹8 h以上. 于胃镜检查时直视下用导管抽取胃液5 mL, 氢氧化钠调整pH为7.0, 以4000 r/min离心10 min后取上清液2 mL -70 ℃冻存待测. 剔除胃液中有明显血液、胆汁者. TNF-α, CA19-9和CEA测定用IRMA法, 采用GC-911型g放射免疫计数器对标本进行检测. 胃液参考值采用胃良性患者组(乙组)总体均数95%可信区间的上限作为阳性值标准, 计算出TNF-α, CA19-9, CEA分别为6.12 mg/L, 42.11 IU/L, 21.32 mg/L.
统计学处理 使用SPSS 11.5统计软件对数据进行分析, 计量资料用mean±SD表示, 两组计量资料的比较使用t检验, 多组计量资料的比较使用方差分析, P<0.05认为有显著性统计学差异.
胃癌组与胃良性病变组相比, 数值有明显的差异(P均<0.001); 胃良性病变组之间无统计学意义(P>0.05, 表1). 胃液各指标中TNF-α的灵敏度、特异度、阳性预期值、阴性预期值和阳性似然比均高于CA19-9和CEA(表2).
| 检测指标 | 灵敏度(%) | 特异度(%) | 阳性预期值(%) | 阴性预期值(%) | 阳性似然比 |
| TNF-α | 69.1 | 75.4 | 65.9 | 77.9 | 2.81 |
| CA19-9 | 65.7 | 67.2 | 58.3 | 74.6 | 2.03 |
| CEA | 61.9 | 70.5 | 59.1 | 72.9 | 2.09 |
消化道肿瘤早期多无明显症状和体征, 部分患者就诊时已失去治疗机会, 因此早期诊断十分重要. 国内外有用单一肿瘤标志物检测消化道肿瘤的报道, 但诊断阳性率都不高. van Eeden et al[1]指出与血液中CEA相比, 胃液中CEA检测对于胃癌诊断具有更大的价值. 而联合检测胃液中的肿瘤标志物是诊断消化道肿瘤新的尝试[2-3]. 胃液中CA19-9和CEA都是较好的消化道肿瘤标志物[4], 而TNF-α作为致炎因子在胃癌的发生、发展中起着重要的作用, 他是内源性的肿瘤促进剂[5]. 胃液各指标中TNF-α的灵敏度、特异度、阳性预期值、阴性预期值和阳性似然比均高于CA19-9和CEA. 但其单独应用诊断效果仍然偏低, 而联合检测可提高其敏感度、特异性, 增加胃癌诊断的准确度[3,6]. 研究证明[2-3,6-7], 将数种标志物按一定方式进行联合检测可起到优势互补的作用, 可明显提高胃癌诊断的准确度. 本研究结果提示, 虽然两项指标联合测定能够提高胃癌诊断的灵敏度, 但胃液中TNF-α, CEA, CA19-9三者同时检测的组合方式可获得更高的灵敏度和特异度, 能够提高胃癌诊断的准确度, 是临床诊断胃癌的一种有效的辅助手段.
目前关于血液中胃肠道肿瘤标志物联合检测报道较多, 但对于胃液中指标研究较少, 且临床价值意义评价不一.
本研究检测老年胃癌患者胃液中TNF-α, CA19-9, CEA的水平, 并探讨了不同组合的敏感度、特异度, 此组合方式在国内外未见相同报道.
本文报道了老年胃癌患者胃液中TNF-α, CA19-9和CEA联合检测的临床价值, 具有一定的可读性.
电编: 张敏 编辑:王晓瑜
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