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胃癌是消化系统最常见的恶性肿瘤, 在我国胃癌的发病率和死亡率均居恶性肿瘤之首, 并持续居高不下。临床初次诊断的胃癌中, 约1/3的患者具有区域淋巴结转移, 约1/3的患者具有内脏转移, 仅1/4~1/3的患者肿瘤病灶局限于胃癌, 因此, 对胃病患者进行定期检查, 尽早诊断和治疗胃癌患者是当务之急。本文对126例胃癌患者血浆中的胃泌素、瘦素、糖类抗原125(carbohydrate antigen 125, CA125)、糖类抗原72-4(carbohydrate antigen 72-4, CA72-4)水平和13C-尿素呼气试验(13C-urea breath test, 13C-UBT)测定幽门螺旋杆菌(helicobacter pylori, HP)感染的阳性率进行研究。现将结果报道如下。
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126例胃癌患者中, 血浆中的胃泌素、CA125和CA72-4较60名正常对照者明显升高(t分别为3.125、3.519、3.788, P均 < 0.01), 并随疾病的严重程度而增加; 血浆中的瘦素较正常对照组明显降低(t=3.524, P < 0.01), 并随疾病的严重程度而减少。血浆CA72-4水平在胃癌Ⅰ~Ⅱ期、Ⅲ期和Ⅳ期较之正常对照组均升高非常明显(t分别为3.218、3.776、3.813, P均 < 0.01), 故其诊断胃癌价值最高; 其次是瘦素、CA125和胃泌素, 其中, 胃癌Ⅰ~Ⅱ期患者血浆胃泌素水平甚至与正常组与明显差异(t=1.134, P > 0.05)(表 1)。
例数 胃泌素(pg/ml) 瘦素(ng/ml} CA125(U/ml) CA72-4(U/ml) 正常对照组 60 60.1 ±20.8 7.53 ±3.81 18.6 ±8.5 3.21 ±1.18 胃癌组 126 112.6 ±35.8 4.73 ±2.93 45.9 ±28.4 46.35 ±18.62 Ⅰ~Ⅱ期 32 65.4 ±30.5 6.21 ±2.75 26.3 ±17.1 28.54 ± 13.20 Ⅲ期 57 10L8±35.6 4.74 ±3.66 47.5 ± 26.8 41.82 ± 18.54 Ⅳ期 37 171.2±40.3 3.25 ± 2.43 63.9 ±38.8 68.69 ±24.12 注: 表中, CA125:糖类抗原125;CA72-4:糖类抗原72-4。 表 1 60名正常对照者与126例胃癌患者血清中4种肿瘤标志物的水平比较(x±s)
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126例胃癌患者HP感染的阳性率为84%, 其中, Ⅰ~Ⅱ期、Ⅲ期和Ⅳ期胃癌患者HP感染的阳性率分别为46.9%、89.5%和89.2%, 呈逐级递增趋势; 而60名正常对照者感染的阳性率仅为15.0%。
血浆中四种肿瘤标志物和13C-尿素呼气试验对胃癌诊断的对比研究
Clinical application of four plasma tumor markers and 13C-urea breath test in diagnosis of patients with gastric carcinoma
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摘要:
目的 探讨胃癌患者血浆中胃泌素、瘦素、糖类抗原125(CA125)、糖类抗原72-4(CA72-4)水平和13C-尿素呼气试验(13C-UBT)对胃癌诊断的对比研究。 方法 采用放射免疫分析法、酶免疫吸附测定法测定126例胃癌患者(其中Ⅰ~Ⅱ期32例、Ⅲ期57例和Ⅳ期37例)和60名正常对照者血浆中胃泌素、瘦素、CA125和CA72-4水平;用13C-UBT测定幽门螺旋杆菌(HP)感染的阳性率并进行比较性分析。 结果 126例胃癌患者血浆中的胃泌素、CA125和CA72-4水平较60名正常对照者均明显升高(t分别为3.125、3.519、3.788,P均 < 0.01),并随疾病的严重程度而增加;血浆瘦素水平较60名正常对照者明显降低(t=3.524,P < 0.01),并随疾病的严重程度不断减少。与正常对照组相比,4种肿瘤标志物中CA72-4水平变化最明显。126例胃癌患者HP感染的阳性率为84.9%,其中,Ⅰ~Ⅱ期、Ⅲ期和Ⅳ期胃癌患者HP感染的阳性率分别为46.9%、89.5%和89.2%;60名正常对照者HP感染的阳性率为15.0%。 结论 通过对126例胃癌患者血浆中胃泌素、瘦素、CA125和CA72-4水平的分析表明,血浆中的CA72-4水平诊断胃癌为最佳,其次为瘦素、CA125及胃泌素。因胃癌与HP的关系密切,故尽早使用13C-UBT测定HP感染和治疗HP感染者甚为重要。 Abstract:Objective To investigate clinical value of plasma gastrin, leptin, carbohydrate antigen 125(CA125), carbohydrate antigen 72-4(CA72-4)and 13C-urea breath test(13C-UBT)in diagnosis of patients with gastric carcinoma. Methods Radioimmunoassay and enzyme immunosorbent assay were used to determine the plasma gastrin, leptin, CA125 and CA72-4 levels, and helicobacter pylori(HP)infection rate was determined by 13C-UBT.Compared all the determined results from 126 patients with gastric carcinoma (including 32 casesⅠ-Ⅱstage gastric carcinoma, 57 casesⅢstage gastric carcinoma and 37 casesⅣstage gastric carcinoma)and 60 normal controls. Results The plasma gastrin, CA125 and CA72-4 levels in 126 patients with gastric carcinoma were significantly higher(t=3.125, t=3.519, t=3.788, P < 0.01)but plasma level was significantly lower(t=3.524, P < 0.01)than those in 60 normal controls.Compared with normel controls, the result of CA72-4 was signeficantly changed.The plasma gastrin, CA125 and CA72-4 levels in 126 patients with gastric carcinoma were increased with the severity of gastric carcinoma, but plasma leptin was decreased. The HP infection rate in 126 patients with gastric carcinoma(84.9%)were significantly higher than those in 60 normal controls(15%).The HP infection rate in 32Ⅰ-Ⅱ, 57Ⅲand 37Ⅳstage gastric carcinoma were 46.9%, 89.5%and 89.2%respectively and were increased with severity of gastric carcinoma. Conclusion The determination of plasma CA72-4 was the best item for diagnosis of gastric carcinoma in four tumor markers, leptin, CA125 and gastrin followed.The determination of HP infection rate in gastric carcinoma by 13C-UBT played a considerable role for diagnosis and therapy. -
表 1 60名正常对照者与126例胃癌患者血清中4种肿瘤标志物的水平比较(x±s)
例数 胃泌素(pg/ml) 瘦素(ng/ml} CA125(U/ml) CA72-4(U/ml) 正常对照组 60 60.1 ±20.8 7.53 ±3.81 18.6 ±8.5 3.21 ±1.18 胃癌组 126 112.6 ±35.8 4.73 ±2.93 45.9 ±28.4 46.35 ±18.62 Ⅰ~Ⅱ期 32 65.4 ±30.5 6.21 ±2.75 26.3 ±17.1 28.54 ± 13.20 Ⅲ期 57 10L8±35.6 4.74 ±3.66 47.5 ± 26.8 41.82 ± 18.54 Ⅳ期 37 171.2±40.3 3.25 ± 2.43 63.9 ±38.8 68.69 ±24.12 注: 表中, CA125:糖类抗原125;CA72-4:糖类抗原72-4。 -
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