血清CA19-9、CA125、CEA、ALP单独及联合检测对胆囊癌的诊断及临床分期意义

发布时间：2017-12-28 20:39

本文关键词：血清CA19-9、CA125、CEA、ALP单独及联合检测对胆囊癌的诊断及临床分期意义　出处：《青海大学》2015年硕士论文　论文类型：学位论文

【摘要】：第一部分血清CA19-9、CA125、CEA、ALP单独及联合检测对胆囊癌的诊断的敏感性目的:近年来,由于原发性胆囊癌在我国的发病率呈缓慢上升趋势,有学者调查2008年上海市流行病学调查研究显示胆囊癌总体发病率较2001年增长了5.5%。原发性胆囊癌早期诊断困难,发现时多属于中晚期,且手术切除率低。目前,对于原发性胆囊癌无特异性检测指标。本文通过分析血清CAl9-9、CAl25、CEA、ALP及四者联合检测对原发性胆囊癌的诊断应用价值,提高原发性胆囊癌的诊断率。方法:回顾性分析青海大学附属医院普外科自2002年1月至2012年12月收治的40例胆囊癌患者作为恶性组,同期住院的40例胆囊良性疾病患者作为良性组,以及同期门诊体检者40例作为对照组,采用美国雅培公司I 2000全自动化学发光免疫分析仪检测三组血清CAl9-9、CAl25、CEA、ALP,分析上述指标单独及其四者联合检测对于原发性胆囊癌诊断的敏感性。结果:恶性组与胆囊良性病变和健康体检者比较,胆囊癌血清CAl9-9、CAl25、CEA、ALP水平升高(P0.05);CAl9-9、CAl25、CEA、ALP联合检测诊断胆囊癌的敏感性、阳性预测值、准确率均高于单独检测。结论:胆囊癌血清学CAl9-9、CAl25、CEA、ALP联合检测可提高胆囊癌的诊断率。第二部分血清CA19-9、CA125、CEA、ALP单独及联合检测对胆囊癌的临床分期意义目的:原发性胆囊癌是胆道系统恶性肿瘤中最常见的恶性肿瘤,位居胆道肿瘤首位。胆囊癌早期缺乏特异性的临床表现,早期诊断率低,易与慢性胆囊炎、胆囊结石及胆囊息肉等良性病变相混淆,由于胆囊癌发病隐匿、进展迅速,当出现临床症状时多已属于中晚期,此时患者行手术率低且行手术后5年生存率低。早期胆囊癌行单纯胆囊切除术后5年生存率可达95%-100%。本文通过重点分析胆囊癌的血清学指标CAl9-9、CAl25、CEA、ALP,探讨与胆囊癌早期诊断相关的血清指标,以提高胆囊癌的诊断率,为胆囊癌的临床分期、术前评估及手术方式选择提供依据,改善预后。方法:回顾性分析青海大学附属医院普外科自2002年1月至2012年12月收治的原发性胆囊癌的患者68例,全部为手术或术后病理检查确诊,对不同TNM分期原发性胆囊癌患者的血清CAl9-9、CAl25、CEA、ALP进行比较分析。根据TNM分期是否有淋巴结转移分为无区域淋巴结转移组(I期+Ⅱ期+ⅢA期)、区域淋巴结转移组(ⅢB期)、远处淋巴结转移组(Ⅳ期)3组;根据TNM分期,按是否可行根治术分可行根治性切除(I+Ⅱ+ⅢA期)组和不可行根治性切除(ⅢB期+Ⅳ期)组。结果:有无淋巴结转移3组间血清CAl9-9、CAl25、CEA和ALP水平相比差异均有统计学意义;无区域淋巴结转移组血清CA19-9、CEA阳性率和ALP异常率显著低于区域淋巴转移及远处转移组(P0.01),血清CA125阳性率显著低于远处转移组(P0.01)。可行根治性切除组血清CAl9-9、CEA水平和阳性率及ALP水平和异常率显著低于不可行根治切除组(P0.01),血清CA125水平及阳性率无明显差异。胆囊癌血清CAl9-9、CAl25、CEA、ALP四者联合检测阳性率显著高于单一指标检测的阳性率(P0.01)。结论:胆囊癌血清学CAl9-9、CAl25、CEA、ALP联合检测作为辅助诊断手段并对胆囊癌的临床分期和术前评估有一定的临床应用价值,四者联合应用可对胆囊癌的诊断率明显提高。
[Abstract]:The purpose of the first part the sensitivity of serum CA19-9, CA125, CEA, ALP single and combined detection in diagnosis of gallbladder carcinoma: in recent years, due to primary gallbladder cancer incidence in our country is slowly rising, there is an epidemiological study scholars survey in Shanghai city in 2008 shows that the total incidence rate of gallbladder cancer increased by 5.5% compared to 2001. The early diagnosis of primary gallbladder carcinoma is difficult, and most of them are in the middle and late stages, and the surgical resection rate is low. At present, there is no specific detection index for primary gallbladder carcinoma. The diagnostic value of combined detection of serum CAl9-9, CAl25, CEA, ALP and four components in primary gallbladder cancer is analyzed in this paper, so as to improve the diagnosis rate of primary gallbladder carcinoma. Methods: a retrospective analysis of the Department of general surgery of Affiliated Hospital of Qinghai University from January 2002 to December 2012 were 40 cases of gallbladder cancer patients hospitalized in the same period as the malignant group, 40 cases of benign gallbladder diseases as benign group, and over the same period patient examination in 40 cases as control group, using the United States Abbott Company I 2000 full automatic chemiluminescence immunoassay analyzer to detect the serum CAl9-9, three group CAl25, CEA, ALP, analysis of the index alone and four combined detection sensitivity for the diagnosis of primary gallbladder carcinoma. Results: the serum levels of CAl9-9, CAl25, CEA and ALP increased (P0.05) in malignant group compared with benign lesions of gallbladder and healthy subjects. The sensitivity, positive predictive value and accuracy of combined detection of CAl9-9, CAl25, CEA and ALP were all higher than those of single detection. Conclusion: the combined detection of CAl9-9, CAl25, CEA and ALP in the serology of gallbladder cancer can improve the diagnostic rate of gallbladder cancer. The second part is the clinical significance of serum CA19-9, CA125, CEA and ALP alone and combined detection. The purpose is: primary gallbladder carcinoma is the most common malignant tumor in biliary tract malignancies, ranking the first place in biliary tract tumors. The clinical manifestation of gallbladder cancer early lack of specificity, low early diagnosis rate, easily confused with chronic cholecystitis, cholelithiasis and gallbladder polyps and other benign lesions, due to advances in occult onset, gallbladder cancer rapidly, when clinical symptoms appear when have been in the late fall, the patients underwent low 5 years survival rate is low and the line after the operation. The survival rate of 5 years after simple cholecystectomy for early gallbladder carcinoma can reach 95%-100%. This paper focuses on the analysis of gallbladder cancer CAl9-9, CAl25, CEA markers, ALP, serum indicators associated with early diagnosis of gallbladder carcinoma, in order to improve the diagnostic rate of gallbladder carcinoma, provide the basis for selection of clinical staging of gallbladder carcinoma, preoperative evaluation and surgical methods, improve the prognosis. Methods: a retrospective analysis of 68 cases of patients in the Department of general surgery of Affiliated Hospital of Qinghai University from January 2002 to December 2012 were of primary gallbladder carcinoma, all surgical or postoperative pathology, comparative analysis of serum CAl9-9, CAl25, CEA, ALP for different TNM staging of primary gallbladder carcinoma patients. According to TNM staging and lymph node metastasis to lymph node metastasis group (I + II + III A), regional lymph node metastasis group (stage B) and distant lymph node metastasis group (IV) group 3; according to TNM stage, according to the feasibility of radical resection of feasible points excision (I+ II + III A) group and non radical resection (B stage III + IV group). Results: there was no lymph node metastasis between the 3 groups of serum CAl9-9, CAl25, CEA and ALP levels had a significant difference; no regional lymph node metastasis group serum CA19-9, CEA positive rate and the abnormal rate of ALP was significantly lower than that of regional lymph node metastasis and distant metastasis group (P0.01), the positive rate of serum CA125 was significantly lower than that of distant metastasis group (P0.01). In the feasible radical resection group, serum CAl9-9, CEA level and positive rate, ALP level and abnormal rate were significantly lower than those in the unfeasible radical resection group (P0.01). There was no significant difference in serum CA125 level and positive rate. The positive rate of the combined detection of serum CAl9-9, CAl25, CEA and ALP four in the serum of gallbladder cancer was significantly higher than that of the single index (P0.01). Conclusion: the combined detection of CAl9-9, CAl25, CEA and ALP in gallbladder carcinoma is a useful diagnostic tool and has certain clinical value for clinical staging and preoperative evaluation of gallbladder carcinoma. The combined application of the four can improve the diagnostic accuracy of gallbladder carcinoma.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.8

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