AFP、CA19-9、CEA联合检测对原发性肝癌的早期诊断价值

李嘉妍; 宋金云; 王建芳; 吴旭平

doi:10.3969/j.issn.1001-5256.2017.07.017

AFP、CA19-9、CEA联合检测对原发性肝癌的早期诊断价值

DOI: 10.3969/j.issn.1001-5256.2017.07.017

东南大学附属第二医院临床科研中心

详细信息

中图分类号: R735.7
计量
- 文章访问数: 3950
- HTML全文浏览量: 114
- PDF下载量: 562
- 被引次数: 8
出版历程
- 收稿日期: 2016-12-01
- 出版日期: 2017-07-20

Value of combined detection of AFP, CA19-9, and CEA in early diagnosis of primary liver cancer

Clinical Research Center, The Second Affiliated Hospital of Southeast University

摘要

摘要: 目的研究AFP、CA19-9、CEA联合检测对原发性肝癌进行早期诊断的临床价值。方法收集2014年10月-2016年12月东南大学附属第二医院门诊和住院的肝病患者248例,分为原发性肝癌组（n=88）和非肿瘤性肝病组（n=160）,另选取130例健康体检者为正常对照组。采用Roche cobas e 411 analyzer检测3组患者的血清肿瘤标志物AFP、CA19-9、CEA水平,分析3种肿瘤标志物单个检测和联合检测的灵敏度和特异度。采用Beckman Coulter AU5800检测肝功能生化指标。采用Biotek ELX808检测HBV血清学标志物和HCV抗体。应用受试者工作特征曲线（ROC曲线）对原发性肝癌患者的血清AFP、CA19-9、CEA及3者联合检测结果进行分析评价。计量资料多组间比较采用单因素方差分析,进一步两两比较采用SNK-q检验,2组间比较采用t检验;计数资料组间比较采用χ2检验。相关性分析采用Spearman分析。结果在原发性肝癌组和非肿瘤性肝病组中,肝功能异常患者的AFP、CA19-9均显著高于肝功能正常组（原发性肝癌组:t值分别为3...
- 肝肿瘤 /
- 甲胎蛋白类 /
- CA-19-9抗原 /
- 癌胚抗原 /
- 诊断
Abstract: Objective To investigate the value of combined measurement of alpha-fetoprotein (AFP) , carbohydrate antigen 19-9 (CA19-9) , and carcinoembryonic antigen (CEA) in the early diagnosis of primary liver cancer.Methods A total of 248 patients who visited the outpatient service or were hospitalized in The Second Hospital of Nanjing from October 2014 to December 2016 were enrolled and divided into primary liver cancer group with 88 patients and non-tumor liver disease group with 160 patients.A total of 130 healthy subjects who underwent physical examination were enrolled as normal control group.The Roche cobas e 411 analyzer was used to measure the serum levels of the tumor markers AFP, CA19-9, and CEA, and the sensitivities and specificities of these markers or a combination of them were analyzed.Beckman Coulter AU5800 was used to measure biochemical parameters for liver function, and Biotek ELX808 was used to measure hepatitis B virus markers and HCV antibody.The receiver operating characteristic (ROC) curve was used to analyze the results of measurements of serum AFP, CA19-9, and CEA alone or in combination in patients with primary liver cancer.A one-way analysis of variance was used for comparison of continuous data between multiple groups and the SNK-q test was used for further comparison between two groups;the t-test was used for comparison of continuous data between two groups.The chi-square test was used for comparison of categorical data between groups.The Spearman correlation analysis was also performed.Results In the primary liver cancer group and the non-tumor liver disease group, the patients with abnormal liver function had significantly higher levels of AFP and CA19-9 than those with normal liver function (primary liver cancer group:t=35.64 and 3.38, both P<0.05;non-tumor liver disease group:t=12.51 and 8.19, both P<0.05) .Among the patients with normal liver function, the primary liver cancer group had a significantly higher level of CEA than the non-tumor liver disease group and the normal control group (all P<0.05) .Among the patients with abnormal liver function, the primary liver cancer group had significantly higher levels of AFP, CA19-9, and CEA than the non-tumor liver disease group and the normal control group (all P<0.05) .The serum levels of AFP, CA19-9, and CEA increased with the increase in Child-Pugh class.Among the patients with abnormal liver function in the primary liver cancer group, Child-Pugh class B patients had significant increases in the levels of AFP, CA19-9, and CEA compared with Child-Pugh class A patients, and Child-Pugh class C patients had significant increases compared with Child-Pugh class B patients (all P<0.05) .Among the patients with abnormal liver function in the non-tumor liver disease group, Child-Pugh class B patients had significant increases in the levels of AFP and CA19-9 compared with Child-Pugh class A patients, and Child-Pugh class C patients had significant increases compared with Child-Pugh class B patients (all P<0.05) ;Child-Pugh class C patients had a significant increase in the level of CEA than Child-Pugh class A/B patients (P<0.05) .The primary liver cancer group had significantly higher positive rates of AFP, CA19-9, and CEA than the non-tumor liver disease group and the normal control group (all P<0.05) , and the positive rates of these tumor markers were significantly higher when measured in combination than when measured alone (all P<0.05) .In the primary liver cancer group, a combination of the three tumor markers had a sensitivity of 86.36% and a specificity of 92.35%, while AFP, CA19-9, and CEA measured alone had sensitivities of 71.59%, 52.27%, and 39.77%, respectively.In the patients with primary liver cancer, the areas under the ROC curve for serum AFP, CA19-9, CEA, and a combination of them were 0.776, 0.704, 0.681, and0.817, respectively.AFP was positively correlated with gamma-glutamyl transpeptidase in the primary liver cancer group (r=0.54, P=0.04) and was positively correlated with indirect bilirubin (IBil) in the normal control group (r=0.50, P=0.01) .In the primary liver cancer group, CA19-9 was positively correlated with alanine aminotransferase (ALT) , direct bilirubin (DBil) , IBil, total bilirubin (TBil) , and total bile acid (TBA) (r=0.58, 0.63, 0.61, 0.65, and 0.58, all P<0.05) , and in the non-tumor liver disease group, CA19-9 was positively correlated with ALT, alkaline phosphatase (ALP) , DBil, IBil, TBil, and TBA (r=0.51, 0.63, 0.66, 0.64, 0.70, and 0.59, all P<0.05) .Conclusion AFP can well reflect liver injury, but it may yield false-negative results in the diagnosis of primary liver cancer.A mild increase in CEA does not strongly indicate primary cancer.CA19-9 is easily influenced by the factors including ALP and bilirubin and has a high false-positive rate.Combined measurement of AFP, CA19-9, and CEA can improve the sensitivity of the diagnosis of primary liver cancer and is better than single measurement of AFP, CA19-9, or CEA.Therefore, it provides a strong basis for early diagnosis and treatment.
- liver neoplasms /
- alpha-fetoproteins /
- CA-19-9 antigen /
- carcinoembryonic antigen /
- diagnosis

HTML全文

参考文献(15)

[1]ZHAO YS, ZHANG LN, LI HC, et al.Clinical significance of serum GP73, AFP, and CA199 test in the diagnosis of hepatic cancer[J].Chin J Gastroenterol Hepatol, 2013, 40 (1) :29-32. (in Chinese) 赵运胜, 张丽娜, 李洪臣, 等.血清GP73联合AFP和CA199检测在肝癌诊断中的临床意义[J].中国肿瘤临床, 2013, 40 (1) :29-32.

[2]ZENG YL, MA QF, XIONG W, et al.Relationships between HBV-M patterns and liver function, HBV-DNA in patients with chronic HBV infection of different stages[J].Int J Lab Med, 2015, 36 (4) :433-435. (in Chinese) 曾雅莉, 马清峰, 熊微, 等.不同病期慢性HBV感染者肝功能、HBV-DNA与HBV-M模式的关系[J].国际检验医学杂志, 2015, 36 (4) :433-435.

[3]RAIN AJ, CHAN DW.Cancer proteomics:serum diagnostics for tumor marker discovery[J].Ann N Y Acad Sci, 2004, 1022:286-294.

[4]SI X, TAN GJ.Value of tumor markers carcinoembryonic antigen, alpha-fetoprotein, and carbohydrate antigen 199 in diagnosis of liver cancer[J].Jilin Med J, 2008, 29 (16) :1392-1393. (in Chinese) 司序, 谭桂菊.探讨肿瘤标志物CEA、AFP、CA199在肝癌诊断中的应用价值[J].吉林医学, 2008, 29 (16) :1392-1393.

[5]TIAN MF, HAN B.The clinical value of the detections of CA199, CA125, CA153 and CEA in malignant tumors[J].J Clin Exp Med, 2010, 9 (7) :483-485. (in Chinese) 田满福, 韩波.检测CA199、CA125、CA153及CEA在肿瘤诊断中的意义[J].临床和实验医学杂志, 2010, 9 (7) :483-485.

[6]ZHANG N, WANG YX, HU J, et al.Application of levels of serum CA199, C3, C4 and lipid metabolism in clinical diagnosis of pancreatic cancer[J].J Jilin Univ:Med Edit, 2016, 42 (2) :295-300. (in Chinese) 张宁, 王颖娴, 胡健, 等.血清CA199、C3、C4及脂类代谢水平在胰腺癌临床诊断中的应用[J].吉林大学学报, 2016, 42 (2) :295-300.

[7]GUO HM.Value of measurement of serum CA199 levels for diagnosis of hepatocirrhosis and carcinoma of liver[J].J Radioimmunol, 2003, 16 (4) :207-208. (in Chinese) 郭红梅.血清CA199在肝硬化与肝癌诊断中的价值[J].放射免疫学杂志, 2003, 16 (4) :207-208.

[8]HUANG HT, ZHANG XF.CA199 Clinical significance of carbohydrate antigen 199 in liver cirrhosis and liver cancer[J].J Clin Hepatol, 2006, 22 (5) :379-380. (in Chinese) 黄海涛, 张筱风.CA199在肝硬化和肝癌中的临床意义[J].临床肝胆病杂志, 2006, 22 (5) :379-380.

[9]DONG JZ, DENG ZY, ZHANG F, et al.Diagnostic value of combined detection of AFP, CEA and CA199 in primary liver cancers[J].Med J Natl Defend Forces Northwest China, 2011, 32 (4) :276-277. (in Chinese) 董菊子, 邓芝云, 张峰, 等.AFP、CEA和CA199联合检测在原发性肝癌诊断中的应用[J].西北国防医学杂志, 2011, 32 (4) :276-277.

[10]ZHU W, GE JL, ZHANG LQ, et al.Clinical value of combined determination of alpha-fetoprotein, carcinoembryonic antigen, carbohydrate antigen 199, and cancer antigen 125 in diagnosis of liver cancer and liver cirrhosis[J].Int J Lab Med, 2012, 33 (15) :1902-1904. (in Chinese) 朱薇, 葛君琍, 张利强, 等.AFP、CEA、CA199、CA-125联合检测对肝癌、肝硬化诊断的临床价值[J].国际检验医学杂志, 2012, 33 (15) :1902-1904.

[11]MEI Y, PENG CJ, CHEN L, et al.Early detective value of serum CA199 levels for concomitant acute cholangitis in obstructive jaundice[J].Chin J Pract Surg, 2015, 35 (4) :445-447. (in Chinese) 梅永, 彭瓷军, 陈丽, 等.血清CA199早期预判梗阻性黄疸发生急性胆管炎临床价值研究[J].中国实用外科杂志, 2015, 35 (4) :445-447.

[12]RUAN SL, BI J.Influence of liver function on the detection of common tumor markers[J].World Chin J Dig, 2008, 16 (24) :2780-2784. (in Chinese) 阮水良, 毕军.肝功能生化指标对常用肿瘤标志物检测的影响[J].世界华人消化杂志, 2008, 16 (24) :2780-2784.

[13]XIN WJ, ZHAO WJ.Combined detection of GP73, AFP and CA-199 in the diagnosis of primary liver cancer[J].Mod Oncol, 2016, 24 (7) :1083-1084. (in Chinese) 辛文娟, 赵文静.GP73、AFP、CA-199联合检测在原发性肝癌诊断中的应用价值[J].现代肿瘤医学, 2016, 24 (7) :1083-1084.

[14]ZHENG HL, ZHAO R, LI DP, et al.Utility of DCP and AFP in diagnosis of primary liver cancer[J].Chin J Gen Prac, 2016, 14 (1) :29-31. (in Chinese) 郑海伦, 赵睿, 李大鹏, 等.肿瘤标志物DCP和AFP在原发性肝癌中的诊断价值[J].中华全科医学, 2016, 14 (1) :29-31.

[15]ASUM N, CHOWDHURY HUA, CHOWDHURY MR, et al.Correlation of serum alpha-fetoprotein (AFP) level with liver function parameters in hepatitis B virus (HBV) infected patients in Bangladeshi population[J].Int JBiosci, 2012, 2 (9) :13-19.

施引文献

期刊类型引用(4)

1.	曹丹，陈祺，陈小橹，陈林珍，王海燕，郝巨辉，张威，马志强. 基于Nrf2/HO-1信号通路探讨四逆散对胆汁淤积性肝炎大鼠氧化应激反应的影响. 中国实验方剂学杂志. 2024(12): 1-7 . 百度学术
2.	平烨，张珮雯，袁馨梦，项梦奇，杨梦凡，林小霞，董诗茹，刘宇婷，张媛. 运动调节Nrf2/HO-1通路改善HFFC膳食诱导肝细胞氧化应激的作用研究. 中国实验动物学报. 2024(05): 566-575 . 百度学术
3.	黄志远，邹蕾，李娇，崔婷婷. 急性药物性肝损伤患者血清核因子E_2相关因子2、血红素加氧酶-1、脂肪酸结合蛋白4、缺氧诱导因子1α表达意义及其与肝功能指标相关性研究. 陕西医学杂志. 2024(07): 983-986 . 百度学术
4.	罗美美，朱星宇，胡乐涛，吴育，李伟东. 基于Nrf2/HO-1信号通路的中药有效成分缓解肝损伤研究进展. 药物评价研究. 2024(07): 1638-1644 . 百度学术