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目的探讨联合检测血清CA72-4、CA242、CA19-9和癌胚抗原(CEA)对胃癌的诊断价值。方法采用电化学发光法测定193例胃癌患者、106例胃良性疾病患者和86例健康对照者血清CA72-4、CA242、CA19-9和CEA水平,进行单因素方差分析、Logistic回归-ROC曲线和偏最小二乘-判别分析(PLS-DA)。结果Ⅰ~Ⅱ期胃癌组患者血清CA242和CEA水平显著高于良性疾病组和健康对照组(P<0.05)。胃癌组Ⅲ~Ⅳ期患者血清CA72-4、CA242、CA19-9和CEA水平显著高于Ⅰ~Ⅱ期、良性疾病组和健康对照组(P<0.01)。4种标志物联合的Logistic回归-ROC曲线下面积为0.956(95%置信区间:0.938~0.957),临界值(概率)为0.56,敏感度和特异性分别为86.0%和95.3%。PLS-DA模型对胃癌组和非胃癌组(胃部良性疾病+健康对照)的分类正确率分别为83.4%和81.8%。PLS-DA模型对Ⅰ~Ⅱ期和Ⅲ~Ⅳ期胃癌的分期诊断正确率分别为100.0%和82.9%。结论基于血清CA72-4、CA242、CA19-9的PLS-DA模型有助于胃癌的鉴别和分期诊断。
Objective To investigate the diagnostic value of combined detection of serum CA72-4, CA242, CA19-9 and carcinoembryonic antigen (CEA) in gastric cancer. Methods The serum levels of CA72-4, CA242, CA19-9 and CEA in 193 patients with gastric cancer, 106 patients with gastric benign disease and 86 healthy controls were determined by using electrochemiluminescence method. One-way ANOVA, Logistic regression-ROC curve and Partial Least Squares - Discriminant Analysis (PLS-DA). Results The levels of serum CA242 and CEA in stage Ⅰ ~ Ⅱ gastric cancer patients were significantly higher than those in benign disease groups and healthy controls (P <0.05). Serum levels of CA72-4, CA242, CA19-9 and CEA in stage Ⅲ ~ Ⅳ gastric cancer patients were significantly higher than those in stage Ⅰ ~ Ⅱ, benign disease group and healthy control group (P <0.01). Logistic regression-ROC curves for the four markers combined showed that the area under the ROC curve was 0.956 (95% confidence interval: 0.938-0.957), the cut-off value (probability) was 0.56, and the sensitivity and specificity were 86.0% and 95.3%, respectively. The classification accuracy of PLS-DA model in gastric cancer group and non-gastric cancer group (benign gastric disease + healthy control) was 83.4% and 81.8% respectively. PLS-DA model stage Ⅰ ~ Ⅱ and stage Ⅲ ~ Ⅳ staging diagnostic accuracy rates were 100.0% and 82.9%. Conclusion PLS-DA model based on serum CA72-4, CA242 and CA19-9 is helpful for the differential diagnosis and staging of gastric cancer.