2018 年第 3 期 第 13 卷

乳腺癌患者部分外周血指标的变化及肿瘤标志物的诊断价值

Diagnostic values of peripheral blood indexes and tumor markers for breast cancer

作者：张璐璐刘芸段文冰唐闻李晓莹赵万辉张炳昌

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单位：250021济南，山东大学附属省立医院临床医学检验部

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• 摘要：

• 目的    探讨乳腺癌患者血常规、血脂、血生化等指标的变化及血清糖类抗原125、糖类抗原153、癌胚抗原联合检测对乳腺癌的诊断价值。方法    选取2016年8月至2017年5月山东大学附属省立医院收治的女性乳腺癌患者92例（乳腺癌组，其中有淋巴结转移59例、无淋巴结转移33例）、女性乳腺良性肿瘤患者41例（乳腺良性肿瘤组）、体检健康女性50名（健康对照组），采用化学发光法检测3组研究对象癌胚抗原、糖类抗原125、糖类抗原153的含量,并对乳腺癌组及健康对照组外周血红细胞体积分布宽度(RDW)、血细胞比容（HCT）、中性粒细胞计数（NEU）与淋巴细胞计数(LYM)的比值（NLR）、血清唾液酸、前白蛋白、糖化血清蛋白（GSP）和血脂进行检测。结果    ①乳腺癌组的RDW、NLR、唾液酸、GSP、总胆固醇、三酰甘油均高于健康对照组，HCT、LYM、前白蛋白、高密度脂蛋白胆固醇均低于健康对照组（均P<0.05）。无淋巴结转移组RDW、NEU、NLR、GSP均低于有淋巴结转移组，LYM、前白蛋白高于有淋巴结转移组（均P<0.05）。②乳腺癌组的糖类抗原125、糖类抗原153、癌胚抗原含量明显高于乳腺良性肿瘤组和健康对照组（均P<0.05）。乳腺癌组3项联合检测的阳性率高于癌胚抗原、糖类抗原125、糖类抗原153单独检测［43.5%（40/92）比15.2%（14/92）、14.1%（13/92）、23.9%（22/92）］（均P<0.05）。③在3项肿瘤标记物中，糖类抗原153诊断乳腺癌的敏感度为23.91%，特异度为98.00%，准确度为50.00%，阴性预测值为41.18%，阳性预测值为95.61%，是单项检测中最佳的乳腺癌诊断指标；3项联合检测的敏感度为43.48%，准确度为61.97%，阴性预测值为48.00%。3项肿瘤标志物联合诊断乳腺癌的受试者工作特征曲线下面积大于癌胚抗原、糖类抗原125单独检测（0.805比0.704、0.701）（P<0.05），与糖类抗原153的曲线下面积（0.757）比较差异无统计学意义（P>0.05）。结论    乳腺癌患者RDW、NLR、GSP等指标对乳腺癌的转移有着重要的参考价值。癌胚抗原、糖类抗原125、糖类抗原153联合检测大大提高了乳腺癌早期诊断阳性率。

• Objective    To analyze the values of blood routine test, blood lipid and biochemical indexes, carbohydrate antigen（CA）125, CA153 and carcinoembryonic antigen（CEA） in diagnosis of breast cancer. Methods    Ninety-two breast cancer patients were enrolled from August 2016 to May 2017 in Shandong Provincial Hospital Affiliated to Shandong University; 59 of them had lymphatic metastasis. Forty-one patients with benign breast tumor and 50 healthy women were enrolled as control. CA125, CA153 and CEA were tested by chemiluminescent immunoassay in all subjects. Peripheral blood red blood cell volume distribution width(RDW), hematocrit（HCT）, neutrophil count（NEU）, lymphocyte count(LYM), NEU/LYM ratio（NLR）, serum sialic acid（SA）, prealbumin（PA）, glycosylated serum protein（GSP） and blood lipid were tested in breast cancer patients and healthy women. Results    RDW, NLR, SA, GSP, total cholesterol, triacylglycerol in breast cancer patients were significantly higher and HCT, LYM, PA, high-density lipoprotein cholesterol were significantly lower than those in healthy women（P<0.05）. RDW, NEU, NLR, GSP in lymphatic metastasis patients were significantly lower and LYM, PA were significantly higher than those in breast cancer patients without metastasis(P<0.05). CA125, CA153 and CEA in breast cancer patients were significantly higher than those in benign breast tumor patients and healthy women(P<0.05). Positive diagnosis rate of combined test of CA125, CA153 and CEA was significantly higher than that of CA125, CA153, CEA individual tests［43.5%（40/92） vs 15.2%（14/92）, 14.1%（13/92）, 23.9%（22/92）］（P<0.05）. CA153 was a good individual indicator in diagnosis of breast cancer (sensitivity＝23.91%; specificity＝98.00%; accuracy＝50.00%; negative predictive value＝41.18%; positive predictive value＝95.61%). Sensitivity, accuracy and negative predictive value of combined test were 43.48%, 61.97% and 48.00%. Area under the operating characteristic curve of combined test was significantly larger than that of CEA and CA125 individual tests（0.805 vs 0.704, 0.701）（P＜0.05）; there was no significant difference between combined test CA153 individual test（0.757）（P>0.05）. Conclusions    RDW, NLR and GSP have important values in diagnosis of metastasis in breast cancer patients. Combined detection of CEA, CA125 and CA153 can improve the early diagnosis rate of breast cancer.