Application of combined dynamic detection of serum tumor markers in the diagnosis and treatment of breast cancer
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摘要:目的 探讨血清肿瘤标记物血清糖类抗原153(CA153)、血清糖类抗原125(CA125)、骨桥蛋白(OPN)不同组合动态联合检测对乳腺癌诊断和监控治疗的价值。方法 选取98例乳腺癌患者、50例乳腺良性病变患者和50例健康体检者分别为乳腺癌组、良性对照组和正常对照组，采用电化学发光法检测3组人群血清CA153、CA125, 酶联免疫法检测OPN水平，分析血清肿瘤标记物CA153、CA125、OPN水平与乳腺良恶性疾病的相关性。结果 ① 乳腺癌组患者血清CA153、CA125、OPN水平显著高于良性对照组和健康对照组(P < 0.01), 良性对照组和正常对照组比较无显著差异(P>0.05); ②乳腺癌患者血清CA153、CA125、OPN水平与患者年龄、肿瘤发生部位无显著相关性(P>0.05), 与肿瘤大小、临床分期、转移、复发及治疗后显著相关; 乳腺癌高分期(Ⅲ、Ⅳ期)患者血清CA153、CA125、OPN水平显著高于低分期(Ⅰ、Ⅱ期)患者(P < 0.01); 转移与无转移患者、复发与无复发患者比较差异有统计学意义(P < 0.01); 治疗后，血清CA153、CA125、OPN水平与治疗前比较显著降低(P < 0.01); ③血清CA153、CA125、OPN 3项联合检测诊断乳腺癌的敏感性、准确性与各单项及部分组合检测比较显著提高。结论 血清CA153、CA125、OPN 3项联合检测的乳腺癌诊断检出率显著较高，误漏诊减少，有利于临床早期发现和早期干预。同时，联合动态检测能够监控肿瘤转移、复发，判断预后。Abstract:Objective To explore the clinical value of differently and dynamically combined detection of serum carbohydrate antigen 153(CA153), serum carbohydrate antigen 125 (CA125) and osteopontin (OPN) for the diagnosis and monitoring of breast cancer.Methods A total of 98 patients with breast cancer, 50 patients with benign breast lesions and 50 healthy donors were as breast cancer group, benign control group and normal control group. The levels of serum CA153, CA125 in three groups were detected through electrochemiluminescence, and the level of OPN was measured by enzyme-linked immunosorbent. The correlations between the levels of CA153, CA125, OPN and benign, malignant breast diseases were analyzed.Results ① The levels of serum CA153, CA125 and OPN in the breast cancer group were obviously higher than the benign group and healthy control group (P < 0.01). There was no significant difference between the benign control group and the normal control group (P>0.05). ② The serum CA153, CA125 and OPN levels in patients with breast cancer were not correlated with age and tumor location (P>0.05), while were significantly correlated with the tumor size, clinical staging, metastasis, recurrence and post-treatment. The levels of serum CA153, CA125 and OPN in the breast cancer patients with high stagings (Ⅲ, Ⅳ) were significantly higher than those with low stagings (Ⅰ, Ⅱ) (P < 0.01), and there were significant differences between patients with lymph node metastasis and those with non-metastasis, between recurrence patients and those without (P < 0.01). Furthermore, the levels of serum CA153, CA125 and OPN after treatment were obviously decreased compared with treatment before (P < 0.01). ③ The sensitivity and accuracy of combined detection of serum CA153, CA125 and OPN were significantly improved compared with detection alone or partial combined detection.Conclusion The diagnostic detection of serum CA153, CA125 and OPN in combination for breast cancer has significantly higher detection rate, and decreased misdiagnosis and missed diagnosis, which is helpful for early clinical discovery and intervention. Meanwhile, the dynamically combined detection can monitor the tumor metastasis and recurrence, assess the prognosis.
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Keywords:
- breast cancer /
- tumor markers /
- serology /
- combined detection /
- diagnosis and treatment
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表 1 3组血清肿瘤标记物水平比较(x±s)
组别 n CA153/(U/mL) CA125/(U/mL) OPN/(ng/mL) 乳腺癌组 98 56.78±19.45* 72.45±22.31* 196.24±78.92* 良性对照组 50 15.02±8.16 20.67±10.41 30.05±13.64 健康对照组 50 14.25±8.72 19.05±9.42 28.97±12.63) CA153: 血清糖类抗原153; CA125: 血清糖类抗原125; OPN: 骨桥蛋白。与良性对照组和健康对照组比较, *P < 0.01。 
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表 2 乳腺癌不同临床特征患者血清CA153、CA125、OPN水平比较(x±s)
指标 n CA153/(U/mL) CA125/(U/mL) OPN/(ng/mL) 年龄 ≥50岁 56 55.69±18.48 74.04±22.18 197.78±81.73 <50岁 42 57.32±21.48 70.33±27.67 195.15±79.34 肿瘤部位 左 57 58.29±27.57 71.59±22.32 198.23±79.67 右 41 54.12±22.36 73.65±25.63 194.35±75.69 肿瘤直径 ≥5 cm 46 74.23±36.79* 91.34±36.45* 250.36±89.23* <5 cm 52 40.57±12.67 55.86±18.63 149.35±63.24 临床分期 Ⅰ+Ⅱ 49 37.97±10.64 52.62±16.31 125.67±56.37 Ⅲ+Ⅳ 49 75.36±30.12* 92.43±40.32* 267.82±96.31* 远处转移 无 81 48.23±13.54 62.58±20.39 174.72±62.38 有 17 97.23±42.35* 120.69±56.34* 301.59±103.28* 复发 无 86 20.13±7.64 31.89±12.67 70.37±32.56 有 12 88.67±36.54* 113.67±52.67* 287.39±96.42* 治疗 前 98 56.78±19.45 72.45±22.31 196.24±78.92 后 98 25.37±7.98* 38.74±13.70* 84.11±42.97* CA153: 血清糖类抗原153; CA125: 血清糖类抗原125; OPN: 骨桥蛋白。与组内另一项比较, *P < 0.01。
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表 3 血清肿瘤标记物单项及联合检测诊断乳腺癌的价值比较[n(%)]
检测指标 敏感性 特异性 准确性 阳性预测值 阴性预测值 CA153 52(53.06) 47(94.00) 99(66.89) 52(94.55) 47(50.54) CA125 50(51.02) 46(92.00) 96(64.86) 50(92.59) 46(48.94) OPN 51(52.04) 46(92.00) 97(65.54) 51(92.73) 46(49.46) CA153+CA125 76(77.55) 44(88.00) 120(81.08) 76(92.68) 44(66.67) CA153+OPN 66(67.35) 43(86.00) 109(73.65) 66(90.41) 43(57.33) CA125+OPN 67(68.37) 45(90.00) 112(75.68) 67(93.06) 45(59.21) CA153+CA125+OPN 95(96.94)* 40(80.00) 135(91.22)* 95(90.48) 40(93.02)* CA153: 血清糖类抗原153; CA125: 血清糖类抗原125; OPN: 骨桥蛋白。与其他检测方法比较, *P < 0.05。
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