本文關(guān)鍵詞：血清CA19-9、CA125、CEA、ALP單獨(dú)及聯(lián)合檢測(cè)對(duì)膽囊癌的診斷及臨床分期意義　出處：《青海大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 膽囊腫瘤 膽囊癌 腫瘤分期 單獨(dú)及聯(lián)合檢測(cè) 癌胚抗原 糖類抗原CA19-9 糖類抗原CA125 堿性磷酸酶

【摘要】：第一部分血清CA19-9、CA125、CEA、ALP單獨(dú)及聯(lián)合檢測(cè)對(duì)膽囊癌的診斷的敏感性目的:近年來,由于原發(fā)性膽囊癌在我國(guó)的發(fā)病率呈緩慢上升趨勢(shì),有學(xué)者調(diào)查2008年上海市流行病學(xué)調(diào)查研究顯示膽囊癌總體發(fā)病率較2001年增長(zhǎng)了5.5%。原發(fā)性膽囊癌早期診斷困難,發(fā)現(xiàn)時(shí)多屬于中晚期,且手術(shù)切除率低。目前,對(duì)于原發(fā)性膽囊癌無特異性檢測(cè)指標(biāo)。本文通過分析血清CAl9-9、CAl25、CEA、ALP及四者聯(lián)合檢測(cè)對(duì)原發(fā)性膽囊癌的診斷應(yīng)用價(jià)值,提高原發(fā)性膽囊癌的診斷率。方法:回顧性分析青海大學(xué)附屬醫(yī)院普外科自2002年1月至2012年12月收治的40例膽囊癌患者作為惡性組,同期住院的40例膽囊良性疾病患者作為良性組,以及同期門診體檢者40例作為對(duì)照組,采用美國(guó)雅培公司I 2000全自動(dòng)化學(xué)發(fā)光免疫分析儀檢測(cè)三組血清CAl9-9、CAl25、CEA、ALP,分析上述指標(biāo)單獨(dú)及其四者聯(lián)合檢測(cè)對(duì)于原發(fā)性膽囊癌診斷的敏感性。結(jié)果:惡性組與膽囊良性病變和健康體檢者比較,膽囊癌血清CAl9-9、CAl25、CEA、ALP水平升高(P0.05);CAl9-9、CAl25、CEA、ALP聯(lián)合檢測(cè)診斷膽囊癌的敏感性、陽(yáng)性預(yù)測(cè)值、準(zhǔn)確率均高于單獨(dú)檢測(cè)。結(jié)論:膽囊癌血清學(xué)CAl9-9、CAl25、CEA、ALP聯(lián)合檢測(cè)可提高膽囊癌的診斷率。第二部分血清CA19-9、CA125、CEA、ALP單獨(dú)及聯(lián)合檢測(cè)對(duì)膽囊癌的臨床分期意義目的:原發(fā)性膽囊癌是膽道系統(tǒng)惡性腫瘤中最常見的惡性腫瘤,位居膽道腫瘤首位。膽囊癌早期缺乏特異性的臨床表現(xiàn),早期診斷率低,易與慢性膽囊炎、膽囊結(jié)石及膽囊息肉等良性病變相混淆,由于膽囊癌發(fā)病隱匿、進(jìn)展迅速,當(dāng)出現(xiàn)臨床癥狀時(shí)多已屬于中晚期,此時(shí)患者行手術(shù)率低且行手術(shù)后5年生存率低。早期膽囊癌行單純膽囊切除術(shù)后5年生存率可達(dá)95%-100%。本文通過重點(diǎn)分析膽囊癌的血清學(xué)指標(biāo)CAl9-9、CAl25、CEA、ALP,探討與膽囊癌早期診斷相關(guān)的血清指標(biāo),以提高膽囊癌的診斷率,為膽囊癌的臨床分期、術(shù)前評(píng)估及手術(shù)方式選擇提供依據(jù),改善預(yù)后。方法:回顧性分析青海大學(xué)附屬醫(yī)院普外科自2002年1月至2012年12月收治的原發(fā)性膽囊癌的患者68例,全部為手術(shù)或術(shù)后病理檢查確診,對(duì)不同TNM分期原發(fā)性膽囊癌患者的血清CAl9-9、CAl25、CEA、ALP進(jìn)行比較分析。根據(jù)TNM分期是否有淋巴結(jié)轉(zhuǎn)移分為無區(qū)域淋巴結(jié)轉(zhuǎn)移組(I期+Ⅱ期+ⅢA期)、區(qū)域淋巴結(jié)轉(zhuǎn)移組(ⅢB期)、遠(yuǎn)處淋巴結(jié)轉(zhuǎn)移組(Ⅳ期)3組;根據(jù)TNM分期,按是否可行根治術(shù)分可行根治性切除(I+Ⅱ+ⅢA期)組和不可行根治性切除(ⅢB期+Ⅳ期)組。結(jié)果:有無淋巴結(jié)轉(zhuǎn)移3組間血清CAl9-9、CAl25、CEA和ALP水平相比差異均有統(tǒng)計(jì)學(xué)意義;無區(qū)域淋巴結(jié)轉(zhuǎn)移組血清CA19-9、CEA陽(yáng)性率和ALP異常率顯著低于區(qū)域淋巴轉(zhuǎn)移及遠(yuǎn)處轉(zhuǎn)移組(P0.01),血清CA125陽(yáng)性率顯著低于遠(yuǎn)處轉(zhuǎn)移組(P0.01)�？尚懈涡郧谐M血清CAl9-9、CEA水平和陽(yáng)性率及ALP水平和異常率顯著低于不可行根治切除組(P0.01),血清CA125水平及陽(yáng)性率無明顯差異。膽囊癌血清CAl9-9、CAl25、CEA、ALP四者聯(lián)合檢測(cè)陽(yáng)性率顯著高于單一指標(biāo)檢測(cè)的陽(yáng)性率(P0.01)。結(jié)論:膽囊癌血清學(xué)CAl9-9、CAl25、CEA、ALP聯(lián)合檢測(cè)作為輔助診斷手段并對(duì)膽囊癌的臨床分期和術(shù)前評(píng)估有一定的臨床應(yīng)用價(jià)值,四者聯(lián)合應(yīng)用可對(duì)膽囊癌的診斷率明顯提高。
[Abstract]:The purpose of the first part the sensitivity of serum CA19-9, CA125, CEA, ALP single and combined detection in diagnosis of gallbladder carcinoma: in recent years, due to primary gallbladder cancer incidence in our country is slowly rising, there is an epidemiological study scholars survey in Shanghai city in 2008 shows that the total incidence rate of gallbladder cancer increased by 5.5% compared to 2001. The early diagnosis of primary gallbladder carcinoma is difficult, and most of them are in the middle and late stages, and the surgical resection rate is low. At present, there is no specific detection index for primary gallbladder carcinoma. The diagnostic value of combined detection of serum CAl9-9, CAl25, CEA, ALP and four components in primary gallbladder cancer is analyzed in this paper, so as to improve the diagnosis rate of primary gallbladder carcinoma. Methods: a retrospective analysis of the Department of general surgery of Affiliated Hospital of Qinghai University from January 2002 to December 2012 were 40 cases of gallbladder cancer patients hospitalized in the same period as the malignant group, 40 cases of benign gallbladder diseases as benign group, and over the same period patient examination in 40 cases as control group, using the United States Abbott Company I 2000 full automatic chemiluminescence immunoassay analyzer to detect the serum CAl9-9, three group CAl25, CEA, ALP, analysis of the index alone and four combined detection sensitivity for the diagnosis of primary gallbladder carcinoma. Results: the serum levels of CAl9-9, CAl25, CEA and ALP increased (P0.05) in malignant group compared with benign lesions of gallbladder and healthy subjects. The sensitivity, positive predictive value and accuracy of combined detection of CAl9-9, CAl25, CEA and ALP were all higher than those of single detection. Conclusion: the combined detection of CAl9-9, CAl25, CEA and ALP in the serology of gallbladder cancer can improve the diagnostic rate of gallbladder cancer. The second part is the clinical significance of serum CA19-9, CA125, CEA and ALP alone and combined detection. The purpose is: primary gallbladder carcinoma is the most common malignant tumor in biliary tract malignancies, ranking the first place in biliary tract tumors. The clinical manifestation of gallbladder cancer early lack of specificity, low early diagnosis rate, easily confused with chronic cholecystitis, cholelithiasis and gallbladder polyps and other benign lesions, due to advances in occult onset, gallbladder cancer rapidly, when clinical symptoms appear when have been in the late fall, the patients underwent low 5 years survival rate is low and the line after the operation. The survival rate of 5 years after simple cholecystectomy for early gallbladder carcinoma can reach 95%-100%. This paper focuses on the analysis of gallbladder cancer CAl9-9, CAl25, CEA markers, ALP, serum indicators associated with early diagnosis of gallbladder carcinoma, in order to improve the diagnostic rate of gallbladder carcinoma, provide the basis for selection of clinical staging of gallbladder carcinoma, preoperative evaluation and surgical methods, improve the prognosis. Methods: a retrospective analysis of 68 cases of patients in the Department of general surgery of Affiliated Hospital of Qinghai University from January 2002 to December 2012 were of primary gallbladder carcinoma, all surgical or postoperative pathology, comparative analysis of serum CAl9-9, CAl25, CEA, ALP for different TNM staging of primary gallbladder carcinoma patients. According to TNM staging and lymph node metastasis to lymph node metastasis group (I + II + III A), regional lymph node metastasis group (stage B) and distant lymph node metastasis group (IV) group 3; according to TNM stage, according to the feasibility of radical resection of feasible points excision (I+ II + III A) group and non radical resection (B stage III + IV group). Results: there was no lymph node metastasis between the 3 groups of serum CAl9-9, CAl25, CEA and ALP levels had a significant difference; no regional lymph node metastasis group serum CA19-9, CEA positive rate and the abnormal rate of ALP was significantly lower than that of regional lymph node metastasis and distant metastasis group (P0.01), the positive rate of serum CA125 was significantly lower than that of distant metastasis group (P0.01). In the feasible radical resection group, serum CAl9-9, CEA level and positive rate, ALP level and abnormal rate were significantly lower than those in the unfeasible radical resection group (P0.01). There was no significant difference in serum CA125 level and positive rate. The positive rate of the combined detection of serum CAl9-9, CAl25, CEA and ALP four in the serum of gallbladder cancer was significantly higher than that of the single index (P0.01). Conclusion: the combined detection of CAl9-9, CAl25, CEA and ALP in gallbladder carcinoma is a useful diagnostic tool and has certain clinical value for clinical staging and preoperative evaluation of gallbladder carcinoma. The combined application of the four can improve the diagnostic accuracy of gallbladder carcinoma.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.8

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