喉癌患者血清中 CEA 、CA19-9、CA72-4和CYFRA21-1含量的检测及临床意义

摘要

目的：探讨血清肿瘤标志物癌胚抗原（carcino-embryonic antigen ，CEA ）、糖类抗原19-9（carbohydrate antigen 19-9， CA19-9）、糖类抗原72-4（carbohydrate antigen 72-4，CA72-4）和角化素蛋白片段19（cytokeratin 19 fragments ，CYFRA21-1）在喉癌诊断和治疗中的临床价值。方法：选取2012年1月-2013年6月喉癌患者60例（喉癌组），并选择同期健康体检者60例作为对照组，检测对照组以及喉癌组术前和术后血清CEA、CA19-9、CA72-4和CYFRA21-1含量，并比较肿瘤标志物单独或联合用于检测喉癌的灵敏度、特异度。结果：喉癌组血清CEA、CA19-9、CA72-4和CYFRA21-1含量均显著高于对照组（P＜0．01），喉癌组术前血清CEA、CA19-9、CA72-4和CYFRA21-1含量均显著高于术后（P＜0．01）。这4种肿瘤标志物用于喉癌的诊断时，灵敏度最高的为CA19-9（60．00％），特异度最高的为CA19-9（100％）和CA72-4（100％）；ROC曲线分析显示， CA19-9曲线下面积（area under the curve ，AUC）为0．987，明显高于CEA、CA72-4和CYFRA21-1的AUC ；4种肿瘤标志物联合检测的敏感性明显高于单独检测，差异均有统计学意义（P＜0．05）。结论：血清CEA、CA19-9、CA72-4和CYFRA21-1的检测可用于喉癌的早期诊断，其联合检测可明显提高诊断的敏感性，且具有较好的特异度。%Objective:To explore the clinical value of serum tumor markers ,which are carcino-embryonic antigen (CEA) ,car-bohydrate antigen 19-9 (CA19-9) ,carbohydrate antigen 72-4 (CA72-4) and cytokeratin 19 fragments (CYFRA21-1) ,in early diagnosis and treatment of laryngeal carcinoma .Methods :From January 2012 to June 2013 ,60 patients with laryngeal carcino-ma (case group) were selected ,and 60 corresponding participants in physical examination were also enrolled as healthy controls in this study .The serum contents of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 were measured before and after operation in the two groups .The differences of sensitivity and specificity in detection of laryngeal carcinoma were compared between individual and combined detection of targeted indicators .Results:The serum levels of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 were significantly higher in the study group than those in the control group (P<0 .01) .The serum levels of CEA ,CA19-9 ,CA72-4 and CYFRA21-1 of the study group were significantly higher in pre-operation than those in post-operation ,and the differ-ences were statistically significant (P<0 .01) ,among which CA19-9 showed the highest sensitivity (60 .00% ) ,while CA19-9 and CA72-4 showed the highest specificity (both were 100% ) .ROC curve analysis showed that the area under curve (AUC) of CA19-9 was 0 .987 ,which is significantly higher than those of CEA ,CA72-4 and CYFRA21-1 .The sensitivity of combined de-tection was significantly higher than individual test ,and the differences were statistically significant (P<0 .05) .Conclusions :Detection of serum CEA ,CA19-9 ,CA72-4 and CYFRA21-1 levels can be applied to early diagnosis of laryngeal carcinoma . Combined detection can significantly improve the sensitivity in diagnosis meanwhile maintain the superior specificity .