CAJ | 학술논문

目的探讨对不明原因静脉血栓栓塞症(VTE)患者进行血清学肿瘤指标筛查的临床意义.方法前瞻性注册采集2010年7月1日至2012年12月31日北京协和医院血管外科和浙江大学第一附属医院血管外科的急性VTE患者,选择其中VTE为主要症状,初诊时没有其他明确VTE致病原因的患者总计167例,其中北京协和医院113例,浙江大学附属一院54例.男106例,女61例,平均年龄(52±15)岁.对上述患者均进行血清学肿瘤标志物的筛查,对于有阳性发现的患者进行进一步的超声、CT等全面的辅助检查,以探索肿瘤标志物的临床意义,并对这些患者进行长期随访,以记录患者的远期生存率及肿瘤发生率.结果确诊恶性肿瘤患病率共18例(10.78％),肿瘤标记物阳线似然比:联合筛查为6.70,癌胚抗原(CEA)为24.83,糖蛋白抗原(CA) 199为22.07,CA242为16.56,CA153为13.24,CA125为10.54,CA724为4.97,阴性似然比分别为0.06,0.34,0.57,0.68,0.57,0.24和0.86.CEA的阳线似然比最高,CA125的阴性似然比最低.6、12和24个月的无恶性肿瘤患者和恶性肿瘤组的生存率分别为99.3％,98.6％,98.6％和61.1％,50.0％,31.3％.结论为原发性VTE患者进行恶性肿瘤的筛查是相当重要的,联合多种肿瘤标志物是筛查的最好方法.若条件所限也可筛查CA125和(或)CEA.CA50可不用于筛查VTE患者.
목적 탐토대불명원인정맥혈전전새증(VTE)환자진행혈청학종류지표사사적림상의의.방법 전첨성주책채집2010년7월1일지2012년12월31일북경협화의원혈관외과화절강대학제일부속의원혈관외과적급성VTE환자,선택기중VTE위주요증상,초진시몰유기타명학VTE치병원인적환자총계167례,기중북경협화의원113례,절강대학부속일원54례.남106례,녀61례,평균년령(52±15)세.대상술환자균진행혈청학종류표지물적사사,대우유양성발현적환자진행진일보적초성、CT등전면적보조검사,이탐색종류표지물적림상의의,병대저사환자진행장기수방,이기록환자적원기생존솔급종류발생솔.결과 학진악성종류환병솔공18례(10.78％),종류표기물양선사연비:연합사사위6.70,암배항원(CEA)위24.83,당단백항원(CA) 199위22.07,CA242위16.56,CA153위13.24,CA125위10.54,CA724위4.97,음성사연비분별위0.06,0.34,0.57,0.68,0.57,0.24화0.86.CEA적양선사연비최고,CA125적음성사연비최저.6、12화24개월적무악성종류환자화악성종류조적생존솔분별위99.3％,98.6％,98.6％화61.1％,50.0％,31.3％.결론 위원발성VTE환자진행악성종류적사사시상당중요적,연합다충종류표지물시사사적최호방법.약조건소한야가사사CA125화(혹)CEA.CA50가불용우사사VTE환자.
Objective To verify the significance of prospective serum cancer markers clearance program for primary Venous thromboembolism (VTE) cases.Methods During 1 July 2010 within 31 Dec 2012,data from two Chinese vascular centers was prospective registry.All the cases diagnosed as primary VTE by first vascular physicians were underwent serum cancer markers clearance.Long term follow up was required to confirm real cancer occurrence and long term survival rate.A total of 167 cases (106 male and 61 female) were enrolled in this study.Mean age was 52 ± 15 years old.Results Eighteen cases (10.78％) were finally scanned as malignant.The sensitive of markers:Carcino-embryonic antigen (CEA) 0.67,carbohydrate antigen (CA) 199 0.44,CA242 0.33,CA153 0.44,CA125 0.78,CA724 0.17,combined markers 0.94.The specificity of above markers was 0.97,0.98,0.98,0.97,0.93,0.97 and 0.86.CA 125 showed best sensitive and specificity as a sole marker.The positive likelihood ratio for markers:CEA 24.83 ((95％ CI 8.95-68.90),CA199 22.07 (95％ CI 6.43-75.78),CA242 16.56 (95 ％ CI 4.53-60.55),CA153 13.24 (95％ CI 4.85-36.17),CA125 10.54 (95％ CI 5.67-19.58),CA 724 4.97 (95％ CI 1.29-19.07),combined of markers 6.70 (95％ CI 4.44-10.12).The negative likelihood ratio for markers:CEA 0.34 ((95％ CI 0.18-0.66),CA199 0.57 (95％ CI 0.37-0.86),CA242 0.68 (95％ CI 0.49-0.94),CA153 0.57 (95％ CI 0.38-0.87),CA125 0.24 (95％ CI 0.10-0.57),CA 724 0.86 (95％ CI 0.76-1.06),combined of markers 0.66 (95％ CI 0.01-0.44).CEA + CA125 showed better positive and negative likelihood ratio.6 months,12 months and 24 months survival rate for malignant (18cases) and non-malignant (149cases) were 61.1％,50.0％,31.3％ and 99.3％,98.6％,98.6％ respectively.Conclusion It is reasonable to screening malignant for "unprovoked" VTE cases.Combined multiple serum cancer markers showed best result.CA125 plus CEA showed acceptable result for some limited condition.CA50 was useless for cancer screening.