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目的探讨四种血清肿瘤标志物在结直肠癌及其肝转移癌中的临床应用价值。方法选取100例结直肠癌患者,按肝有无转移情况分为肝转移组和肝未转移组,各50例,并随机抽取同期健康体检者71例作为对照组,采用电化学发光免疫法检测分析肝转移组、肝未转移组和对照组血清标本甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和铁蛋白(FERRITIN)含量、阳性率,计算肿瘤标志物的敏感度、特异度、准确度、尤登系数。结果肝转移组和肝未转移组的AFP、CA19-9、CEA和FERRITIN的含量均明显高于对照组,比较差异有统计学意义(P<0.05);肝转移组和肝未转移组的CA19-9、CEA和FERRITIN含量比较差异有统计学意义(P<0.05),而两组间AFP含量比较差异无统计学意义(P>0.05)。肝未转移组和肝转移组的AFP和FERRITIN阳性率比较差异具有统计学意义(P<0.05)。在肝未转移组及肝转移组诊断中CEA阳性率最高,分别为94.0%和98.0%。肝未转移组单项检测CEA特异度和准确度都最高,两项联合检测中AFP/CEA敏感度(42.0%)、特异度(100.0%)和准确度(67.3%)都相对CEA/CA19-9、CA19-9/FERRITIN要高;三项联合检测中AFP/CEA/CA19-9的敏感度(48.7%)、特异度(90.4%)和准确度(75.4%)较CEA/CA19-9/FERRITI高。AFP/CEA/CA19-9/FERRITIN四项联合检测敏感度(55.0%)和准确度(80.1%)均比单项或其他联合检测高。肝转移组单项检测AFP的敏感度和准确度都最高,但CEA特异度最高;两项联合检测中CA19-9/FERRITIN的敏感度和准确度都最高,以CA19-9/FERRITIN敏感度较高为43.4%,AFP/CEA特异度和尤登系数最高;三项联合检测中,CEA/CA19-9/FERRITI的敏感度(41.2%)、特异度(88.1%)和准确度(69.2%)较AFP/CEA/CA19-9高,尤登系数均较小;而四项联合检测准确度最高为71.1%。结论血清肿瘤标志物AFP、CEA、CA19-9和FEERRITIN可作为结直肠癌及其肝转移诊断指标,四项肿瘤标志物联合检测可以提高结直肠及肝转移诊断性能和早期检出率。
Objective To investigate the clinical value of four serum tumor markers in colorectal cancer and liver metastases. Methods 100 cases of colorectal cancer patients were divided into hepatic metastasis group and non-hepatic metastasis group according to the presence or absence of liver metastasis, 50 cases in each group, and 71 healthy subjects were randomly selected as the control group. Electrochemiluminescence immunoassay The serum levels of AFP, CEA, CA19-9 and FERRITIN in liver metastasis group, liver metastasis group and control group were analyzed. The positive rate, Calculate the sensitivity, specificity, accuracy, and Youden coefficient of tumor markers. Results The levels of AFP, CA19-9, CEA and FERRITIN in liver metastasis group and non-liver metastasis group were significantly higher than those in control group (P <0.05). The levels of CA19 -9, CEA and FERRITIN levels were significantly different (P <0.05), while there was no significant difference in AFP content between the two groups (P> 0.05). The positive rates of AFP and FERRITIN in the liver metastasis group and liver metastasis group were significantly different (P <0.05). The highest positive rate of CEA was found in the diagnosis of liver metastasis and liver metastasis, which were 94.0% and 98.0% respectively. The specificity and accuracy of CEA for single detection of liver metastasis were the highest, and the sensitivity and specificity of AFP / CEA (42.0%, 100.0%) and accuracy (67.3%) in the two combined tests were all higher than that of CEA / CA19-9 (48.7%), specificity (90.4%) and accuracy (75.4%) of the three combined tests were higher than those of CEA / CA19-9 / FERRITI high. AFP / CEA / CA19-9 / FERRITIN four joint detection sensitivity (55.0%) and accuracy (80.1%) higher than single or other joint detection. The sensitivity and accuracy of AFP in liver metastasis group were the highest, but the specificity of CEA was highest. The sensitivity and accuracy of CA19-9 / FERRITIN in the two combined tests were the highest, and the sensitivity of CA19-9 / FERRITIN was higher (41.2%), specificity (88.1%) and accuracy (69.2%) of CEA / CA19-9 / FERRITI were higher than those of CEA / CA19-9 / FERRITI AFP / CEA / CA19-9 high, Youden coefficient are small; and four joint detection of the highest accuracy of 71.1%. Conclusion Serum tumor markers AFP, CEA, CA19-9 and FEERRITIN can be used as diagnostic indicators of colorectal cancer and liver metastases. The combination of four tumor markers can improve the diagnostic performance and early detection rate of colorectal and liver metastases.