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临床输血与检验

临床输血与检验 ›› 2020, Vol. 22 ›› Issue (4): 434-439.DOI: 10.3969/j.issn.1671-2587.2020.04.023

• 临床检验 • 上一篇    下一篇

血清CEA、CA125联合CA199对晚期肝内胆管细胞癌患者预后的预测作用

李晓洁, 慈雪萍, 张俊   

  1. 237006 六安市中医院检验科（李晓洁, 张俊）;
    六安市中医院肿瘤科（慈雪萍）
  • 收稿日期:2019-03-27 出版日期:2020-08-20 发布日期:2020-08-12
  • 通讯作者: 慈雪萍, 女, 主治医生, 硕士, 主要从事肿瘤内科临床诊疗方面研究, （E-mail）cxpdoctor@sina.com。
  • 作者简介:李晓洁（1981-）, 女, 安徽六安人, 主管技师, 学士, 主要从事临床检验免疫分析方面研究, （E-mail）lixiaojieluan@sohu.com。

Predictive Effect of Serum CEA, CA125 Combined with CA199 on Prognosis of Patients with Advanced Intrahepatic Cholangiocarcinoma

LI Xiao-jie, CI Xu-ping, ZHANG Jun   

  1. Lu'an Hospital of Traditional Chinese Medicine 230076
  • Received:2019-03-27 Online:2020-08-20 Published:2020-08-12

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摘要： 目的 探讨血清癌胚抗原（CEA）、糖类抗原125（CA125）联合糖类抗原199（CA199）对晚期肝内胆管细胞癌（ICC）预后的预测作用。方法 回顾性分析2015年1月~2018年1月医院收治的120例ICC患者的临床资料, 根据随访1年内病情是否进展和死亡将患者分别纳入预后良好组和不良组;对比预后良好组和不良组患者血清CEA、CA125、CA199水平, 并对比2组其他可能导致预后不良影响因素的差异, 采用Logistic回归分析法明确相关危险因素;绘制受试者工作曲线（ROC）, 分析血清CEA、CA125、CA199检测及联合检测对晚期ICC患者预后不良的预测意义。结果 随访1年内, 共91例患者发生预后不良, 其中72例死亡、19例进展生存, 预后不良发生率为75.83%。预后不良组血清CEA、CA125、CA199水平高于预后良好组, 且差异均有统计学意义（P<0.05）;2组性别、年龄、肿瘤直径、合并肝炎、合并肝硬化、Child-Pugh分级、治疗方式、不同血AFP水平患者构成比比较, 差异均无统计学意义（P>0.05）, 预后不良组多发肿瘤、低度分化、TBIL>171 μmol/mL患者构成比均高于预后良好组, 且差异均有统计学意义（P<0.05）;经Logistic回归分析发现, CEA>9.67 ng/mL、CA125>93.23 U/mL、CA199>120.11 U/mL、多发肿瘤、低度分化、TBIL>171 μmol/mL均是导致晚期ICC患者预后不良的独立危险因素（P<0.05）;血清CEA、CA125、CA199预测晚期ICC患者预后不良最佳截断点分别为9.67 ng/mL、93.23 U/mL、120.11 U/mL;血清CEA、CA125、CA199联合检测预测预后不良的灵敏度、特异度和准确度均高于单独检测, 且联合检测预测预后不良的AUC为0.832, 高于单独检测。结论 CEA、CA125、CA199与晚期ICC患者预后不良关系密切, 且与单独检测血清CEA、CA125、CA199相比, 联合检测3种血清学指标对晚期ICC患者预后预测价值更高。

关键词: 癌胚抗原, 糖类抗原125, 糖类抗原199, 晚期肝内胆管细胞癌, 预后

Abstract: Objective To investigate the predictive role of serum carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) in prediction of the prognosis of advanced intrahepatic cholangiocarcinoma (ICC). Methods The clinical data of 120 patients with ICC in the hospital between 2015 and 2018 were retrospectively analyzed. The patients were divided into good prognosis and poor prognosis according to the disease progression and time of survival in one year follow-up. Logistic regression analysis was used to identify the related risk factors. Subject working curve was drawn, and the predictive significance of serum CEA, CA125, and CA199 was analyzed . Results Ninety-one patients had poor prognosis, including 72 deaths and 19 survivals with disease progression. The incidence of poor prognosis was 75.83%, with high levels of serum CEA, CA125 and CA199 (P<0.05). There were no significant differences between the two groups in gender, age, tumor diameter, hepatitis, cirrhosis, Child-Pugh classification, treatment methods as well as the blood AFP concentration (P>0.05). The independent risk factors for the patients with poor prognosis include multiple tumors, low differentiation and high TBIL≥171 μmol/mL (P<0.05). Logistic regression analysis showed that elevated CEA （>9.67 ng/mL）, CA125 (> 93.23 U/mL), CA199 (> 120.11 U/mL), and TBIL(>171 mmol/mL) and multiple tumors with low differentiation were independent risk factors for poor prognosis in patients with advanced ICC (P<0.05). The best cut-off points of serum CEA, CA125 and CA199 for predicting poor prognosis were 9.67 ng/mL, 93.23 U/mL and 120.11 U/mL, respectively. The sensitivity, specificity and accuracy of combined detections of serum CEA, CA125 and CA199 were higher than those of single detection, and the AUC of combined detection was 0.832, higher than that of single detection. Conclusion The serum levels of CEA, CA125 and CA199 are closely related to poor prognosis in patients with advanced ICC, and compared with the serum CEA, CA125 and CA199 detected alone, the serological indicators of the combination detection of the three have higher predictive value for prognosis of patients with advanced ICC.

Key words: Carcinoembryonic, antigen, Carbohydrate, antigen125, Carbohydrate, antigen, 199, Advanced, intrahepatic, cholangiocarcinoma, Prognosis

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