肺癌患者外周血癌胚抗原、 糖类抗原水平与肺癌分期、转移及预后的关系(一)

详细内容

【摘要】 目的:探讨肺癌患者外周血癌胚抗原(CEA)、糖类抗原（CA19-9、CA125、CA15-3）水平与肿瘤分期、转移及预后的关系。方法:用IMMULITE酶放大化学发光免疫分析法检测肺癌、肺部良性疾病和健康对照者各30例外周血CEA、CA19-9、CA125、CA15-3的水平。患者随访2年。结果:肺癌患者外周血CEA、CA125、CA15-3水平高于肺部良性疾病患者及健康对照者，差异有显著性（P＜0.05或P＜0.01）；肺癌患者血CA19-9水平与健康对照者比较差异有显著性（P＜0.05），与肺部良性疾病患者比较差异无显著性。不同分期肿瘤患者间血清CEA、糖类抗原的水平差异无显著性。CEA和CA125呈阳性的肺癌患者转移、复发的机率明显高于阴性患者，其差异有显著性(P＜0.01)，在随访期间共有14位复发或转移肺癌患者死亡。血清CEA阳性患者的预后明显差于阴性患者，两者生存率比较差异有显著性（P＜0.05）。结论:外周血CEA、糖类抗原（CA125）水平的动态检测对肺癌的转移和预后判断有一定的临床意义。

【关键词】 肺癌 癌胚抗原 糖类抗原

Abstract: Objective: To study the value of serum carcinoembryonic antigen(CEA) and carbohydrate antigens (CA15-3, CA19-9 and CA125) in staging, metastasis and prognosis of patients with lung cancer. Methods: The level of CEA, CA15-3, CA19-9 and CA125 were measured in 30 lung cancer, 30 lung benign disease and 30 healthy controls with IMMULITE enzyme amplification chemiluminescence immunoassay system. All patients were followed up for 2 years. Results: The level of CEA, CA15-3 and CA125 in patients with lung cancer was significantly higher than that of pulmonary benign diseases (P＜0.05) and healthy controls(P＜0.01). The level of CA19-9 in patients with lung cancer was significantly higher than that of pulmonary benign diseases(P＜0.01), but had no significant difference when it was pared with pulmonary benign diseases. There had no significant difference in CEA, CA15-3, CA19-9 and CA125 in different stages of lung caner. The possibility of metastasis and recurrence was significantly higher for lung cancer patients with positive CEA and CA125 than those with negative CEA and CA125 (P＜0.01). During the follow-up period, there were 14 patients died of recurrence or metastasis. The prognosis of patients with positive CEA was worse than those with negative CEA, and there was significant difference in survival rate (P＜0.05). Conclusion: The serum CEA and carbohydrate antigens CA125 are valuable in metastasis and prognosis of patients with lung cancer.

Key words: lung cancer; carcinoembryonic antigen; carbohydrate antigen

肺癌是一种恶性程度高、发展快、易向全身转移的恶性肿瘤，5年生存率低于15%，转移和复发是导致死亡率高的主要原因。如能早期发现与监测患者的微转移和复发，及时控制病情，可提高生存率。本资料对外周血癌胚抗原(CEA)、糖类抗原（CA19-9、CA125、CA15-3）水平进行联合检测，以探讨对其肺癌分期、转移和复发、预后评估的价值。

1 对象和方法

1.1 对象 原发性肺癌30例，男21例，女9例，年龄38～79岁，中位年龄64岁。均经病理学确诊，其中鳞癌15例，腺癌11例，小细胞癌4例。依据国际抗癌联盟1997年修订的TNM分期标准，Ⅱ期4例，Ⅲ期12例，Ⅳ期14例。肺部良性疾病患者30例，男19例，女11例，年龄22～76岁，中位年龄61岁。正常健康对照者30例，男22例，女8例，年龄25～72岁，中位年龄59岁。

1.2 主要试剂和仪器 血清CEA蛋白试剂盒、糖类抗原（CA19-9、CA125、CA15-3）试剂盒购于美国罗氏公司，IMMULITE酶放大发光免疫分析系统仪器型号为Elecsys2010。

1.3 血清CEA、糖类抗原（CA19-9、CA125、CA15-3）水平的检测 3组均空腹采静脉血，离心分离血清，采用酶放大发光免疫分析法，按照说明书操作，阳性值按各试剂盒所示确定。

1.4 统计学处理方法 采用SPSS13.0软件进行处理，组间比较用LSD-t检验，各分期比较用方差分析，计数资料的比较采用x2检验。