血清肿瘤标志物联合胆汁酸检测在胃癌诊断中的价值

The Value of Serum Tumor Markers Combined with Bile Acid Detection in the Di-agnosis of Gastric Cancer

摘要: 目的：探讨血清肿瘤标志物(CEA、CA19-9、CA72-4)及胆汁酸(TBA)在胃癌诊断中的价值。方法：收集842例临床资料完整的胃癌患者的数据，采用秩和检验、受试者工作特征曲线分析CEA、CA19-9、CA72-4与TBA单独及联合检测在胃癌诊断中的价值。结果：胃癌组血清CEA、CA72-4、TBA水平明显高于健康对照组(Z = −7.013~−3.387, P < 0.05)，胃癌组与对照组在CEA、CA19-9、CA72-4、TBA不同升高水平间有差异(P < 0.01)，且在升高小于等于1倍时，对照组胃癌患者占比均明显高于胃癌组。CEA升高大于4倍，CA19-9升高1~2倍、2~4倍、大于4倍，CA72-4升高1~2倍、2~4倍、大于4倍，TBA升高1~2倍、2~4倍时，胃癌组胃癌患者占比明显高于对照组。胃癌组不同分化程度血清CEA、CA19-9、CA72-4水平及升高程度均无统计学意义。有淋巴结转移组血清CEA、CA19-9、CA72-4、TBA水平明显高于无淋巴结转移组(Z = −4.897~−1.826, P < 0.01)，有淋巴结转移的患者比例在不同升高水平的血清CEA、CA19-9中均明显高于无淋巴结转移的患者比例(P < 0.01)；胃癌有、无淋巴结转移在不同升高水平的血清CA72-4、TBA中均未见统计学意义(P > 0.05)。血清CEA、CA19-9、CA72-4、TBA联合检测的灵敏度高于单独检测，且四项指标联合检测灵敏度最高。ROC曲线中，CEA、CA72-4、TBA联合检测曲线下面积(AUC)最大为0.616。结论：血清CEA、CA19-9、CA72-4、TBA对胃癌的诊断价值不高，仅当其升高大于4倍时意义较大。只有当血清CEA、CA19-9水平升高大于4倍时，对胃癌是否有淋巴结转移预测价值较大。

Abstract: Objective: To investigate the value of serum tumor markers (CEA, CA19-9, CA72-4) and bile acid (TBA) in the diagnosis of gastric cancer. Methods: The data of 842 gastric cancer patients with com-plete clinical data were collected, and the value of single and combined detection of CEA, CA19-9, CA72-4 and TBA in the diagnosis of gastric cancer was analyzed by Kruskal-Wallis test and receiver operating characteristic curve. Results: The levels of serum CEA, CA72-4 and TBA in gastric cancer group were significantly higher than those in healthy control group (Z = −7.013~−3.387, P < 0.05). There were differences in the levels of CEA, CA19-9, CA72-4, and TBA between the gastric cancer group and the control group (P < 0.01), and when the increase was less than or equal to 1 times, the proportion of gastric cancer patients in the control group was significantly higher than that in the gastric cancer group. The proportion of patients with gastric cancer in the gastric cancer group was significantly higher than that in the control group when CEA increased by more than 4 times, CA19-9 increased by 2 times, 2 times, more than 4 times, CA72-4 increased by 2 times, 2 times, more than 4 times, and TBA increased by 1 times, 2 times, 4 times. There was no statistical signifi-cance in the levels of CEA, CA19-9, CA72-4 and TBA in different degrees of differentiation in gastric cancer group. The serum levels of CEA, CA19-9, CA72-4 and TBA in patients with lymph node me-tastasis were significantly higher than those without lymph node metastasis (Z = −4.897~−1.826, P < 0.01). The proportion of patients with lymph node metastasis was significantly higher than that of patients without lymph node metastasis (P < 0.01). There was no significant difference between gastric cancer with lymph node metastasis and without lymph node metastasis in different elevated levels of serum CA72-4 and TBA (P > 0.05). The sensitivity of combined detection of serum CEA, CA19-9, CA72-4 and TBA was higher than that of single detection, and the sensitivity of combined detection of four indexes was the highest. In the ROC curve, the maximum area under the curve (AUC) of CEA, CA72-4 and TBA joint detection is 0.616. Conclusion: The value of serum CEA, CA19-9, CA72-4 and TBA in the diagnosis of gastric cancer is not high, but it is of great significance only when it increases more than 4 times. Only when the serum levels of CEA and CA19-9 increase more than 4 times, it is of great value in predicting whether there is lymph node metastasis in gastric cancer.