肿瘤标志物检测对老年肝硬化患者的临床诊断价值

Diagnostic value of tumor marker detection for cirrhosis in the elderly

摘要:

目的 探讨肿瘤标志物(TM)糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)、甲胎蛋白(AFP)单项检测及联合检测对老年肝硬化的临床诊断价值。方法 选取2017年3月至2019年3月辽宁省金秋医院门诊及住院确诊的116例老年肝硬化患者为肝硬化组,另选取同时期90名体检健康者为对照组。采用电化学发光法检测2组患者血清CA125、CA19-9、CEA、AFP。比较各组及不同 Child-Pugh 分级肝硬化患者血清 CA125、CA19-9、CEA、AFP 水平；肝硬化患者肝功能生化指标正常及升高者的血清TM水平；各TM指标单项检测及联合检测老年肝硬化的灵敏度、特异度与诊断符合率,分析TM检测对老年肝硬化的诊断意义。采用SPSS 19.0软件对数据进行统计分析。结果 肝硬化组患者血清CA125、CA19-9、CEA、AFP水平均高于正常组(P＜0.05)。与Child-Pugh A级相比,B、C级CA125、CA19-9、AFP、CEA水平均显著升高,差异有统计学意义(P＜0.05)。ALT、DBiL、TBA升高组血清CA125、CA19-9、AFP、CEA水平均高于正常组,但差异无统计学意义。单项TM指标检测老年肝硬化患者的灵敏感为42.4%～62.1%,特异度为80.0%～92.0%,诊断符合率为64.7%～74.1%。CA125、CA19-9、CEA、AFP联合检测的灵敏度为83.3%,特异度为96.0%,诊断符合率为91.4%,各TM指标联合检测对老年肝硬化具有较高的诊断价值(P＜0.05)。结论 血清CA125、CA19-9、CEA、AFP联合检测可明显提高老年肝硬化的检出率,且可以判断肝硬化病情的严重程度,对老年肝硬化具有较高的诊断价值。

Abstract:

Objective To investigate the diagnostic value of single test and combined test of tumor markers (TM), including carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and alpha fetoprotein (AFP), for cirrhosis in the elderly patients. Methods A total of 116 elderly cirrhotic patients diagnosed at the outpatient and inpatient departments of our hospital from March 2017 to March 2019 were enrolled and assigned into the cirrhosis group, while 90 healthy individuals taking physical examination during the same period were selected as the control group. Serum levels of CA125, CA19-9, CEA, and AFP were measured by electrochemiluminescence assay, and the results were compared between the cirrhosis and control groups, between the cirrhotic patients with normal and elevated biochemical parameters of liver function, and among the patients with cirrhosis of different Child-Pugh scores. The sensitivity, specificity, and diagnostic concordance rates of single test and combined test of these TM indicators were compared to analyze the diagnostic significance of the tests for the detection of cirrhosis in the elderly. The data were analyzed by SPSS statistics 19.0. Results Serum levels of CA125, CA19-9, CEA and AFP were significantly higher in the cirrhotic group than the normal group (P<0.05), and in those with Child-Pugh class B and C than those with A (P<0.05). Similar trends were seen in those with elevated ALT, DBiL and TBA levels than those with normal indicators of liver function, but no statistical differences were seen. The sensitivity of single TM indicator test ranged from 42.4% to 62.1%, the specificity from 80.0% to 92.0%, and the diagnostic concordance rate from 64.7% to 74.1%. The combined detection of CA125, CA19-9, CEA and AFP had a sensitivity of 83.3%, a specificity of 96.0%, and a diagnostic concordance rate of 91.4%, and the combined detection of each TM indicator showed a higher diagnostic value for elderly patients with cirrhosis (P<0.05). Conclusion The combined test of serum CA125, CA19-9, CEA and AFP could obviously improve the detection rate of cirrhosis in the elderly, and indicate the severity of the cirrhosis condition. The combined test has a high diagnostic value.