2012 , Vol. 06 >Issue 03: 253 - 258
DOI: https://doi.org/10.3877/cma. j. issn.1674-0807.2012.03.003
血清肿瘤标记物β2微球蛋白、癌胚抗原、CA153和CA125检测对乳腺癌临床实践的意义探讨
Copy editor: 刘军兰
收稿日期: 2012-02-27
网络出版日期: 2024-12-07
版权
Significance of tumor markers including β2-microglobulin, carcino-embryonic antigen, CA153 and CA125 in clinical practice for breast cancer
Received date: 2012-02-27
Online published: 2024-12-07
Copyright
目的
检测乳腺癌患者外周血中β2 微球蛋白(β2-MG)、癌胚抗原(CEA)、CA153、CA125 水平,以探讨外周血β2-MG、CEA、CA153、CA125 在乳腺癌临床实践中的作用。
方法
对140 例乳腺癌患者及144 例健康体检者应用免疫散射比浊法检测外周血β2-MG,用化学发光法检测外周血CEA、CA153、CA125 的水平,数据统计用Kruskal-Wallis 检验、Chi-square 检验和Wilcoxon 秩和检验。
结果
乳腺癌患者外周血β2-MG 和CEA 的检测值分别为1.8 (1.5 ~2.2) mg/L 和1.7(1.2 ~2.4) ng/ml,高于健康对照组[1.5(1.3 ~1.8)mg/L,1.2(0.9 ~1.9)ng/ml,P<0.05],且阳性率高于健康人群(P<0.05);以β2-MG 检测为基础,联合检测未增加诊断的敏感性(P>0.05);以临床分期为参照指标, CA153 在Ⅲ期患者的检测值明显高于Ⅰ期和Ⅱ期患者(P<0.05)。乳腺癌患者术后β2-MG、CEA、CA153 检测均有下降,与术前相比差异有统计学意义(P<0.05)。
结论
以β2-MG 为基础的联合诊断对乳腺癌诊断敏感性未见明显增加;血清CA153 检测水平对乳腺癌预后有一定的预测作用;β2-MG、CEA 和CA153 对乳腺癌术后随访有一定临床意义。
华彬 , 阿合提别克·塔布斯 , 陆旭 , 肖文政 , 韩靖云 , 李波 . 血清肿瘤标记物β2微球蛋白、癌胚抗原、CA153和CA125检测对乳腺癌临床实践的意义探讨[J]. 中华乳腺病杂志(电子版), 2012 , 06(03) : 253 -258 . DOI: 10.3877/cma. j. issn.1674-0807.2012.03.003
Objective
To detect the levels of serum tumor marker β2-microglobulin(β2-MG), CEA, CA153 and CA125 so as to evaluate their clinical significance in clinical treatment of breast cancer.
Methods
The β2-MG level in peripheral blood was detected by nephelometry and the CEA, CA153 and CA125 levels in peripheral blood were determined by chemiluminescence method. Statistical analysis was performed using Kruskal-Wallis test,Chi-square test or Wilcoxon test.
Results
The β2-MG and CEA levels in peripheral blood were 1.8 (1.5-2.2) mg/L and 1.7(1.2-2.4) ng/ml in breast cancer patients respectively,which were higher than those of healthy controls[(1.5(1.3-1.8) mg/L,1.2(0.9-1.9) ng/ml,P<0.05]. The positive rate in breast cancer patients was higher than that in healthy control.On the basis of β2-MG test,combined tests of more than one tumor marker could not increase the sensitivity (P>0.05). According to clinical-pathologic stage, the CA153 level was statistically higher in stage Ⅲpatients than that in stage Ⅰor Ⅱ(P<0.05);After operation,the β2-MG, CEA and CA153 levels in peripheral blood in breast cancer patients were significantly lower than the preoperative levels (P<0.05).
Conclusions
Based on the level of β2-MG in peripheral blood, combined test cannot increase the sensitivity of diagnosis. The CA153 level may be useful in predicting the prognosis. There are significant differences in the levels of tumor markers between preoperative and postoperative breast cancer patients, which imply the importance of tumor markers in follow-up.
Key words： breast neoplasms; diagnosis; prognosis; β2-microglobulin; carcinoembryonic antigen; CA153; CA125
表1 肿瘤标记物在乳腺癌和健康人群中的浓度差异 |
| 肿瘤标记物 | 乳腺癌组[M(QR)] | 健康对照组[M(QR)] | 统计量a | P值 |
|---|---|---|---|---|
| β2-MG(mg/L) | 1.8(1.5~2.2) | 1.5(1.3~1.8) | 5.42 | 0.00 |
| CEA(ng/ml) | 1.7(1.2~2.4) | 1.2(0.9~1.9) | 4.41 | 0.00 |
| CA153(U/ml) | 7.8(6.0~12.5) | 7.3(5.6~10.6) | 1.61 | 0.11 |
| CA125(U/ml) | 10.5(7.8~15.0) | 11.1(7.7~14.4) | 0.22 | 0.82 |
表2 肿瘤标记物在乳腺癌组和健康对照组的阳性率 |
| 肿瘤标记物 | 乳腺癌组(%) | 健康对照组(%) | 统计量 | P值 | 诊断敏感性(%) | 诊断特异性(%) |
|---|---|---|---|---|---|---|
| β2-MG | 46.43(65/140) | 20.83(30/144) | 20.89a | 0.00 | 46.43 | 79.17 |
| CEA | 3.75(5/140) | 0.00(0/144) | 0.03b | 3.75 | 100.00 | |
| CA153 | 1.43(2/140) | 0.69(1/144) | 0.62b | 1.43 | 99.31 | |
| CA125 | 3.75(5/140) | 1.39(2/144) | 0.23b | 3.75 | 98.61 |
表3 肿瘤标记物与临床分期的关系 |
| 肿瘤标记物 | 临床分期[M(QR)] | 统计量a | P值 | ||
|---|---|---|---|---|---|
| Ⅰ | Ⅱ | Ⅲ | |||
| β2-MG(mg/L) | 1.9(1.6~2.2) | 1.8(1.5~2.2) | 1.8(1.5~2.0) | 1.69 | 0.43 |
| CEA(ng/ml) | 1.7(1.3~2.2) | 1.7(1.2~2.4) | 1.8(1.2~2.9) | 0.99 | 0.61 |
| CA125(U/ml) | 10.8(8.2~14.1) | 9.6(7.1~15.7) | 11.1(7.9~18.7) | 0.67 | 0.71 |
| CA153(U/ml) | 6.8(5.5~10.2) | 8.5(6.1~13.4) | 9.2(6.7~14.4) | 7.34 | 0.03 |
表4 乳腺癌患者术前术后血清肿瘤标记物浓度变化的比较 |
| 肿瘤标记物 | 术前[M(QR)] | 术后[M(QR)] | 术前术后差值[M(QR)] | 统计量a | P值 |
|---|---|---|---|---|---|
| β2-MG(mg/L) | 1.8(1.5~2.2) | 1.7(1.5~2.0) | -0.1(-0.3~0.1) | -1743 | 0.00 |
| CEA(ng/ml) | 1.7(1.2~2.4) | 1.4(0.9~1.9) | -0.3(-0.6~0.0) | -2847 | 0.00 |
| CA153(U/ml) | 7.8(6.0~12.5) | 6.5(5.0~10.7) | -1.1(-2.2~(-0.1) | -3036 | 0.00 |
| CA125(U/ml) | 10.3(7.7~15.0) | 10.0(7.0~15.0) | -0.7(-2.4~1.8) | -720 | 0.13 |
表5 β2-MG 为基础联合检验对乳腺癌诊断结果 |
| 检验指标 | 乳腺癌组[例(%)] | 健康对照组[例(%)] | 诊断敏感性(%) | 诊断特异性(%) | 统计量a | P值 |
|---|---|---|---|---|---|---|
| β2-MG | 65(46.43) | 30(20.83) | 46.43 | 79.17 | 0.44 | 1.00 |
| β2-MG+CEA | 65(46.43) | 30(20.83) | 46.43 | 79.17 | ||
| β2-MG+CA125 | 68(48.57) | 32(22.22) | 48.57 | 77.78 | ||
| β2-MG+CA153 | 66(47.14) | 31(21.53) | 47.14 | 78.47 | ||
| β2-MG+CEA+CA125 | 68(48.57) | 32(22.22) | 48.57 | 77.78 | ||
| β2-MG+CEA+CA153 | 66(47.14) | 31(21.53) | 47.14 | 78.47 | ||
| β2-MG+CA153+CA125 | 69(49.29) | 33(22.92) | 49.29 | 77.08 | ||
| β2-MG+CEA+CA153+CA125 | 69(49.29) | 33(22.92) | 49.29 | 77.08 |
| [1] |
Leong SP, Shen ZZ, Liu TJ, et al. Is breast cancer the same disease in Asian and Western countries? [J]. World J Surg,2010,34(10):2308-2324.
|
| [2] |
Bast RC Jr, Ravdin P, Hayes DF, et al. 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology [J]. J Clin Oncol,2001,19(6):1865-1878.
|
| [3] |
汤钊猷. 现代肿瘤学[M]. 第2 版. 上海:上海医科大学出版社,2000:350-356.
|
| [4] |
Arslan N, Serdar M,Deveci S,et al. Use of CA15-3,CEA and prolactin for the primary diagnosis of breast cancer and correlation with the prognostic factors at the time of initial diagnosis[J]. Ann Nucl Med,2000(5),14:395-399.
|
| [5] |
Kokko R, Holli K, Hakama M. CA15-3 in the follow-up of localised breast cancer: a prospective study [J]. Eur J Cancer,2002,38(9):1189-1193.
|
| [6] |
Duffy MJ. Serum tumor markers in breast cancer: are they of clinical value [J]. Clin Chem,2006,52(3):345-351.
|
| [7] |
Pentheroudakis G, Malamou-Mitsi V, Briasoulis E, et al. The neutrophil, not the tumor, serum CA15-3 elevation as a result of granulocyte-colony-stimulating factor-induced neutrophil MUC1 overexpression and neutrophilia in patients with breast carcinoma receiving adjuvant chemotherapy [J]. Cancer,2004,101(8):1767-1775.
|
| [8] |
Martinez-Trufero J, de Lobera AR, Lao J, et al. Serum markers and prognosis in locally advanced breast cancer [J].Tumori,2005,91(6):522-530.
|
| [9] |
张丽,佟仲生,郝春芳,等.血清CA15-3 和CEA 对转移性乳腺癌化疗疗效的预测作用[J].实用肿瘤杂志,2010(1),25:27-31.
|
| [10] |
Molina R, Barak V, van Dalen A, et al. Tumor markers in breast cancer—European Group on Tumor Markers recommendations [J]. Tumor Biol,2005,26(6):281-293.
|
/
| 〈 |
|
〉 |