临床医学论文-血清肿瘤标志物预测乳腺癌骨转移的价值.docVIP

临床医学论文-血清肿瘤标志物预测乳腺癌骨转移的价值 ??????????? 作者：何小江，俞浩，吴华，黄劲雄，俞丹，苏新辉?? 【摘要】? 目的 探讨血清肿瘤标志物预测乳腺癌骨转移的临床价值。方法 应用化学发光免疫检测技术检测174例乳腺癌患者血清CA153、CA125、CEA、FER等四种肿瘤标志物，同时应用SPECT对所有患者行全身骨扫描检查，以明确有无骨转移。结果 174例患者中55例临床诊断为乳腺癌骨转移。CA153、CA125、CEA、FER对诊断骨转移的阳性预测价值分别为68.0%(34/50),70.0%(14/20),88.9%(8/9),53.8%(14/26)，阴性预测价值分别为86.2%(106/123),89.0%(130/146),73.2%(115/157),75.9%(85/112)。一种以上标志物同时阳性或阴性者，其阳性或阴性预测价值增加。结论 CA153、CA125、CEA、FER具有预测乳腺癌骨转移的临床价值，联合检测CA153、CA125、CEA、FER能提高其预测乳腺癌骨转移的准确性。 【关键词】? 血清肿瘤标志物;全身骨扫描;乳腺癌;骨转移;预测价值 ??? Value of Serum Tumor Markers in Predicting Bone Metastases of Breast Cancer ????? The First Hospital of Xiamen，Fujian Medical Universty，Xiamen? 361003，ChinaAbstract：Objective?? To explore the value of serum tumor markers in predicting bone metastases of breast cancer.Methods? Serum tumor markers (CA153、CA125、CEA、FER ) were assayed with CLIA and whole body bone scan were investigated with SPECT on 174 breast cancer patients.Results? Of 174 patients,55 were diagnosed as bone metastases with whole body bone scan.The positive predicting values of CA153、CA125、CEA、FER were 68.0%(34/50),70.0%(14/20),88.9%(8/9),53.8%(14/26),and the negative predicting values of CA153、CA125、CEA、FER were 86.2%(106/123),78.3%(130/166),73.2%(115/157),75.9%(85/112),respectively.The predicting values were increased when more than one serum tumor marker were positive or negative.Conclusions? Serum tumor markers such as CA153、CA125、CEA、FER have clinic value to predicting bone metastases of breast cancer.Combination assay of CA153、CA125、CEA、FER could increase the accuracy of predicting bone metastases. ??? Key words：Serum tumor marker;Whole body bone scan;Breast cancer;Bone metastases;Predicting value ??? 乳腺癌易发生远处转移，其中骨转移发生率仅次肺，死于乳腺癌的病例作尸检50%有骨转移［1］，因此随访观察治疗效果，早期发现复发转移的征兆，赢得及时治疗的机会，极为重要［2］。本文通过对乳腺癌病例血清CA153、CA125、CEA、FER等肿瘤标志物的联合检测，并全部行全身骨显像以证实，探讨其在预测骨转移中的应用价值。 ??? 1资料与方法 ??? 1.1临床资料174例病例均为我院收治的乳腺癌患者，平均年龄49.6岁（30～83岁），其中1例男性，术后病理诊断包括：浸润性导管癌、浸润性小叶癌及导管癌、浸润性单纯癌及腺癌、粉刺样癌、粘液腺癌、髓样癌等，均无其他脏器转移的病例。 ??? 1.2方法