摘要目的 分析单独或联合检测血清肿瘤标志物CA19-9、CA242、CEA、CA724及CA125对胆囊癌患者诊断及预后的临床价值.方法 回顾性分析海军军医大学东方肝胆外科医院2009年3月至2013年12月收治的132例胆囊癌患者的术前血清CA19-9、CA242、CEA、CA724及CA125水平,作敏感性比较;用Kaplan-Meier生存表作单因素生存分析,log-rank法比较是否存在差异.Cox回归模型作多因素生存分析.结果 CA19-9、CA242、CEA、CA724及CA125的敏感性分别为67.4％、63.6％、42.4％、24.2％、22.7％.CA19-9及CA242的敏感性差异无统计学意义(P>0.05),但两者分别与CA125、CEA及CA724比较差异均有统计学意义(均P<0.05);CA19-9分别联合CA125或CEA或CA724,敏感性有所提高,但与CA19-9单独检测相比,差异均无统计学意义(均P>0.05);CA242分别联合CA125或CEA或CA724,敏感性有所提高,但与CA242单独检测相比,差异均无统计学意义(均P>0.05).单因素分析提示,CA19-9、CA242及CEA阳性与阴性患者比较,阳性患者的生存期低于阴性患者,差异均有统计学意义(均P<0.05).Cox回归提示CA242是胆囊癌的独立预后因素.CA242阳性表达与胆囊癌分化程度、淋巴结转移及TNM分期密切相关.结论 CA19-9及CA242在胆囊癌的诊断上有一定的参考价值.CA242是胆囊癌的独立预后因素.

abstractsObjective To analyze the clinical value of serum tumor markers CA19-9, CA242, CEA, CA724 and CA125 in the diagnosis and prognosis of gallbladder carcinoma patients. Methods A retrospective analysis of the preoperative serum levels of CA19-9, CA242, CEA, CA724 and CA125 in 132 patients with gallbladder cancer admitted to Eastern Hepatobiliary Surgery Hospital from March 2009 to December 2013 for sensitivity comparison, Kaplan-Meier survival table was used for univariate survival analysis, and the log-rank method was compared for differences. The Cox regression model was used for multivariate survival analysis. Results The sensitivities of CA19-9, CA242, CA125, CEA and CA724 were 67. 4％, 63. 6％, 42. 4％, 24. 2％ and 22. 7％, respectively. There were no significant differences of the sensitivity between CA19-9 and CA242 (P >0. 05). However, whether CA19-9 or CA242, there were significant differences of diagnostic sensitivity compared to CEA or CA724 or CA125 (all P<0. 05). When CA19-9 was combined with CA125 or CEA or CA724, respectively, the sensitivity was improved, but there was no significant difference compared with CA19-9 alone (all P>0. 05). Similarly, CA242 also has such a situa-tion when compared with CA242 alone (all P>0. 05). Univariate survival analysis showed there were statis-tically significant differences in CA19-9, CA242, and CEA (all P<0. 05). Cox regression suggested that CA242 is an independent prognostic factor for gallbladder carcinoma. CA242 is closely related to histological grade of gallbladder carcinoma, lymph node metastasis and TNM staging. Conclusions CA19-9 and CA242 have definite value in the diagnosis of gallbladder carcinoma. CA242 is an independent prognostic factor for gallbladder carcinoma.