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【Abstract】 Objective To study the diagnostic value of serum carbohydrate antigen125(CA125)in sixty-four patients with primary carcinoma of the liver.Methods 64patients with primary carcinoma of the liver(male of pa-tients44,female of patients20,average age51.5years),46cirrhosis(male of patients26,female of patients20,aver-age age52.8years)and42healthy persons as controls were studied.Blood samples were taken by venipuncture.Serum was separated and frozen at-20℃until the analysis was made.Serum CA125was measured by ELISA.Results Serum CA125with primary carcinoma of the liver(223U/L±134U/L)was significantly higher than that in cirrhosis and normal controls(32U/L±11U/L and2.0U/L±1.9U/L,P<0.01).In cirrhosis group it was higher than that of normal controls(P<0.05),but was markedly lower than in liver carcinoma group(P<0.01).When35U/Lwas taken as the cutoff value,the positive rate with primary carcinoma of the liver group was67.2%.The positive rate of serum CA125in liver carcinoma with positive AFP(AFP>25g/L)was72.5%and thatwith negative AFP(AFP<25ng/ml)was76.0%.Conclusion CA125is a better tumor marker in the diagnosis of with primary carcinoma of the liver.
【Key words】 primary carcinoma of the liver;carbohydrate antigen(CA)125
本文通过检测64例原发性肝癌患者血清CA125,探讨其对原发性肝癌的诊断价值。
1 对象和方法
1.1 对象 原发性肝癌患者64例,男44例,女20例,平均年龄51.5岁;肝硬化患者46例,男26例,女20例,平均年龄52.8岁;以上患者均经B超、CT、实验室检查及临床证实明确诊断。正常对照组42例,男23例,女19例,平均年龄50.4岁,均为正常人群。
1.2 方法 全部标本均采用静脉取血2ml,迅速分离血清,-20℃贮存备测,用ELISA法测定血清CA125含量。血清CA125试剂盒由瑞典康乃格公司提供。操作严格按药盒说明进行,用ASENT SOFTWARE VERSION2.0酶标仪进行测量。测定结果:均数±标准差(ˉx±s)表示,显著性检验采用t检验和χ 2 检验。
2 结果
原发性肝癌患者64例,血清CA125含量为223±134U/L,显著高于肝硬变组和正常对照组(分别为32±11U/L和2.0±1.9U/L,P<0.01)。肝硬化组高于正常对照组(P<0.05),但显著低于原发性肝癌组(P<0.01)。以35U/L为界限值,原发性肝癌的阳性检出率为67.2%(43/64),其中AFP阳性(>25ng/ml)的肝癌中血清CA125的阳性检出率为72.5%(29/40),AFP阴性的肝癌中血清CA125的阳性检出率为24%(6/25)。分析结果见表1及表2。
表1 原发性肝癌组、肝硬化组、对照组三组血清CA125的测定结果 (略)
表2 CA125检测阳性率的结果 (略)
3 讨论
1981年,Bast从乳头状浆液囊性卵巢癌中获得单克隆抗体oc125,该抗体所能识别的肿瘤相关抗原即为CA125,当初此抗原检测主要用在卵巢癌的诊断和预后。以后逐渐有应用于胃癌、结直肠癌、胰腺癌、乳腺癌和肺癌等的报道 [1,2] ,大量临床研究 [3] 证实,CA125在卵巢癌的诊断、良恶性鉴别、复发预报、疗效监测,以及预后判断方面都有极大的实用价值。但用于肝癌和肝硬变的报道较少。在对原发性肝癌的实验室诊断项目中,AFP是公认的诊断原发性肝癌最灵敏的肿瘤标志物,以往也曾报道原发性肝癌患者血清AFP的阳性率为60%~80% [4] ,我们的试验结果显示为原发性肝癌患者血清AFP阳性(>25ng/ml)占总标本量的60.9%(39/64),所以实验室诊断原发性肝癌仅依靠AFP的测定来是有一定难度的。在工作中,我们发现原发性肝癌患者的血清CA125的阳性率为67.2%(43/64),在检测结果中,AFP阳性的肝癌患者血清CA125的阳性率为72.5%(29/40),而AFP阴性的肝癌患者血清CA125的阳性率为76%(19/25)。而且从检测结果中可以发现肝硬化组患者血清CA125高于正常对照组(2.0±1.9U/L,P<0.05),有报道血清CA125在肝硬变的检测中有重要意义 [5],虽然肝硬变组血清CA125含量高于正常对照组(P<0.05),但明显低于原发性肝癌组(P<0.01)。因此我们认为血清CA125的检测可以成为继肿瘤标志物AFP之后的又一个对原发性肝癌辅助诊断有临床意义的肿瘤标记物。
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作者单位:100039北京,武警总医院检验科
073000河北定州,武警8640部队医院