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目的:探讨癌胚抗原(carcinoembryonic antigen,CEA)、骨桥蛋白(osteopontin,OPN)、肿瘤抗原19-9(cancer antigens 199,CA19-9)和神经元特异性烯醇化酶(neural specificity enol,NSE)血清水平检测在胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasm,GEP-NEN)诊断和治疗中的应用。方法:检测56例GEP-NEN患者术前及术后1个月CEA、OPN、CA19-9和NSE血清水平,并与良性肿瘤组(30例)和健康对照组(30名)比较,分析其在GEPNEN诊断和疗效监测中的价值。结果:GEP-NEN组血清CEA、OPN、CA19-9和NSE水平分别为(39.22±21.21)ng/mL、(156.51±42.23)ng/mL、(58.13±13.42)U/mL和(37.21±12.78)ng/mL,明显高于良性肿瘤组的(2.71±2.01)ng/mL、(30.12±8.91)ng/mL、(13.12±6.23)U/mL和(10.47±4.87)ng/mL及健康对照组的(2.57±1.43)ng/mL、(28.89±7.92)ng/mL、(12.72±6.74)U/mL和(9.11±3.19)ng/mL,P值均<0.01;良性肿瘤组与健康对照组比较,差异无统计学意义,P>0.05。GEP-NEN患者术后1个月血清CEA、OPN、CA19-9和NSE水平分别为(21.34±11.34)ng/mL、(89.27±21.78)ng/mL、(38.27±7.23)U/mL和(22.41±7.28)ng/mL,明显低于术前(39.22±21.21)ng/mL、(156.51±42.23)ng/mL、(58.13±13.42)U/mL和(37.21±12.78)ng/mL,差异有统计学意义,P<0.01。NEN血清CEA、OPN、CA19-9和NSE水平与患者年龄、性别和肿瘤部位无关,P>0.05;与肿瘤组织学类型、分级、分期和淋巴结转移有关,P<0.05。CEA、CA19-9和NSE联合检测,可提高敏感性达96.43%,特异性85.00%,准确性90.52%,阴性预测值96.23%,再联合OPN可略提高敏感性,但降低特异性不能提高诊断的准确率。结论:血清CEA、OPN、CA19-9和NSE检测可作为GEP-NEN早期诊断和疗效监测指标,CEA+CA19-9+NSE联合检测敏感性、准确性和阴性预测值较高。
Objective: To investigate the clinical significance of carcinoembryonic antigen (CEA), osteopontin (OPN), cancer antigens 199 (CA19-9) and neural specificity enola (NSE) ) Serum levels in the diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN). Methods: The serum levels of CEA, OPN, CA19-9 and NSE in 56 patients with GEP-NEN before and one month after operation were measured and compared with those in benign tumor group (30 cases) and healthy control group (30 cases) The value of GEPNEN diagnosis and efficacy monitoring. Results: The levels of CEA, OPN, CA19-9 and NSE in the GEP-NEN group were (39.22 ± 21.21) ng / mL, (156.51 ± 42.23) ng / mL, (58.13 ± 13.42) U / mL and (37.21 ± 12.78 ) were significantly higher than those in benign tumor (2.71 ± 2.01 ng / mL, (30.12 ± 8.91) ng / mL, (13.12 ± 6.23) U / mL and (10.47 ± 4.87) ng / mL, respectively) Group (2.57 ± 1.43) ng / mL, (28.89 ± 7.92) ng / mL, (12.72 ± 6.74) U / mL and (9.11 ± 3.19) ng / mL respectively There was no significant difference between the two groups (P> 0.05). The levels of CEA, OPN, CA19-9 and NSE in patients with GEP-NEN at one month after operation were (21.34 ± 11.34) ng / mL, (89.27 ± 21.78) ng / mL, (38.27 ± 7.23) U / mL and (22.41 ± 7.28) ng / mL, which was significantly lower than that of preoperative (39.22 ± 21.21) ng / mL, (156.51 ± 42.23) ng / mL, (58.13 ± 13.42) U / mL and (37.21 ± 12.78) ng / There was statistical significance, P <0.01. The serum levels of CEA, OPN, CA19-9 and NSE in NEN patients were not related to age, sex and tumor location (P> 0.05), but correlated with tumor histological type, grade, stage and lymph node metastasis (P <0.05). The combination of CEA, CA19-9 and NSE could improve the sensitivity of 96.43%, the specificity of 85.00%, the accuracy of 90.52% and the negative predictive value of 96.23%. Combined with OPN can slightly increase the sensitivity, but reduce the specificity can not improve the diagnosis The accuracy rate. Conclusion: Serum CEA, OPN, CA19-9 and NSE can be used as early indicators of diagnosis and treatment of GEP-NEN. The combined detection of CEA + CA19-9 + NSE has higher sensitivity, accuracy and negative predictive value.