血清肿瘤标记物联合动态检测对乳腺癌诊疗的临床应用

目的:探讨血清肿瘤标记物肿瘤抗原CA153、CA125和骨桥蛋白(OPN)不同组合多动态联合检测对乳腺癌诊断和监控治疗的临床应用价值。方法:选取98例乳腺癌患者(乳腺癌组)、50例乳腺良性病变患者(良性对照组)和50例健康体检者(健康对照组)为研究对象,采用电化学发光法检测三组人群血清CA153、CA125,酶联免疫法检测OPN水平,回顾性统计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,探讨CA153、CA125、OPN不同组合多动态联合检测在乳腺癌早期诊断和监控治疗中的临床应用价值。结果:乳腺癌组血清CA153、CA125、OPN水平均明显高于良性对照组和健康对照组(P<0.01),而良性对照组和正常对照组比较,差异均无统计学意义(P>0.05)。乳腺癌患者血清CA153、CA125、OPN水平与年龄、肿瘤发生部位均无明显相关性(P>0.05),与肿瘤大小、临床分期、转移、复发及治疗后明显相关(P<0.05),乳腺癌高分期(Ⅲ、Ⅳ期)血清CA153、CA125、OPN水平均明显高于低分期(Ⅰ、Ⅱ期)(P<0.01);转移组与无转移组、复发组与无复发组血清CA153、CA125、OPN水平比较,差异均有统计学意义(P<0.01);治疗后,血清CA153、CA125、OPN水平与治疗前比较均明显降低(P<0.01)。血清CA153、CA125、OPN三项联合检测诊断乳腺癌的敏感度、准确度与各单项及部分组合检测比较明显提高,分别为96.94%、91.22%。结论:血清CA153、CA125、OPN三项联合检测对乳腺癌诊断检出率明显提高,可减少误漏诊,有利于临床早期发现、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,指导治疗。     

CYFRA21-1、CEA、NSE和CA125联合检测在非小细胞肺癌中的诊断价值

目的:探讨细胞角蛋白19片段(CYFRA21-1)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、糖类抗原125(CA125)联合检测在非小细胞肺癌(NSCLC)中的诊断价值。方法:选取2010年1月-2015年6月本院收治的NSCLC患者92例和肺部良性病变患者95例作为研究对象,92例NSCLC患者根据病理类型的不同分为肺鳞癌组42例和肺腺癌组50例。采用电化学发光法测定所有患者的CYFRA21-1、CEA、NSE及CA125水平。结果:NSCLC组CYFRA21-1、CEA、NSE及CA125均明显高于肺部良性病变组,两组比较差异均有统计学意义(P<0.05)。肺鳞癌以CYFRA21-1敏感性和特异性最高,分别为71.40%和89.10%;肺腺癌以CEA敏感性及特异性最高,分别为60.00%和84.30%。CYFRA21-1对NSCLC诊断的敏感性为46.53%,特异性为85.26%;CEA对NSCLC诊断的敏感性为42.58%,特异性为81.05%;NSE对NSCLC诊断的敏感性为57.43%,特异性为76.85%;CA125对NSCLC诊断的敏感性为48.51%,特异性为66.32%;四项指标联合检测则敏感性为93.26%,特异性为98.25%。结论:CYFRA21-1、CEA、CA125和NSE对NSCLC的早期发现、早期诊断具有一定价值,四者联合检测有明显的互补性,可以显著提高NSCLC的诊断率。     

研究血清多种肿瘤标志物联合检测在肺癌诊断中的价值

目的:研究血清多种肿瘤标志物联合检测在肺癌诊断中的价值,寻找最为有效的肺癌诊断方式。方法:选取自2012年5月-2013年12月入住本院的200例肺癌患者进行癌胚抗原(CEA)、糖类抗癌原199(CA19-9)、糖类癌抗原125(CA125)、神经元特异性烯醇化酶(NSE)和细胞角蛋白片段19(CYFRA21-1)等5个项目的敏感度、准确性和特异度检测。血清癌胚抗原(CEA)、细胞角蛋白片段19(CYFRA21-1)、神经元特异性烯醇化酶(NSE)、糖类抗癌原199(CA19-9)和糖类抗癌抗原125(CA125)均采用化学发光法进行检测,将检测的结果进行统计学数据处理。结果:细胞角蛋白片段19(CYFRA21-1)在单个项目的检测中肺癌诊断的敏感度和准确性最高为(64%和75.6%),然而特异度却是糖类抗癌原199(CA19-9)以(98.8%)排在首位。与单个项目的检测数据相对比联合检测的敏感度和准确性都有着明显的提高,以神经元特异性烯醇化酶(NSE)和细胞角蛋白片段19(CYFRA21-1)(83.6%和82.9%)排在第一,特异度则以糖类癌抗原125(CA125)和糖类抗癌原199(CA19-9)(97.6%)最高。结论:通过结果显示联合检测在肺癌诊断中的敏感度、准确性都有着明显的提高,极大的提高的肺癌诊断的准确率,可以广泛的应用于临床中。     

血清人附睾蛋白4、糖类抗原125检测在上皮性卵巢癌术预后评估中的临床意义

目的:研究血清人附睾蛋白4、糖类抗原125在上皮性卵巢癌术患者预后评估中的应用价值。方法:选择2015年11月-2016年10月于本院诊治的EOC术患者86例纳入EOC组,选择同期健康体检的正常女性86例纳入健康组。EOC组行标准肿瘤细胞减灭术联合化疗治疗,检测治疗前后两组HE4、CA125水平。以术后病理切片结果为金标准,评价HE4、CA125单独与联合检测EOC的敏感度(SEN)、特异度(SPE)、阳性预测值(PV+)、阴性预测值(PV-)等方法学结果。结果:EOC组患者缓解32例(37.21%),复发54例(62.79%),缓解及复发患者基线资料比较差异均无统计学意义(P>0.05)。化疗后1年,缓解、复发患者HE4、CA125水平均高于健康组,比较差异均有统计学意义(P<0.05);复发患者HE4、CA125水平均高于缓解患者,比较差异有统计学意义(P<0.05)。复发患者HE4、CA125单独检测EOC的SEN、SPE、PV+、PV-均低于联合检测。结论:EOC复发患者血清HE4、CA125显著升高,联合检测血清HE4、CA125对于评估EOC患者预后具有重要价值。     

肿瘤标志物联检在卵巢癌早期诊断中的研究

目的探讨肿瘤标志物[人附睾蛋白4（HE4）、糖类抗原125（CA125）及癌胚抗原（CEA）]联合检测在卵巢癌早期诊断中的应用价值。方法对47例卵巢癌患者（卵巢癌组,FIGO临床分期Ⅰ期6例、Ⅱ期12例、Ⅲ期14例、Ⅳ期15例）、63例良性卵巢疾病患者（良性病变组）及78例健康体检育龄妇女（对照组）进行HE4、CA125及CEA检测,观察各组HE4、CA125、CEA血清水平变化及异常率;比较不同FIGO临床分期HE4、CA125、CEA血清水平的变化;对3种肿瘤标志物单独检测和联合检测对卵巢癌诊断的效果进行方法学评价。结果卵巢癌组的HE4、CA125及CEA血清水平及异常率均明显高于良性病变组及对照组（均P〈0.05）,良性病变组与对照组比较差异均无统计学意义（均P〉0.05）;FIGO临床Ⅲ—Ⅳ期卵巢癌组HE4、CA125及CEA血清水平明显高于FIGO临床Ⅰ—Ⅱ期卵巢癌组（均P〈0.001）。3种肿瘤标志物单独检测以HE4及CA125 2项指标较好;3种肿瘤标志物联合检测对灵敏度、诊断符合率、约登指数及阴性预测值均有不同程度的提升。结论 HE4、CA125及CEA联合检测对卵巢癌的防治有重要的临床意义。     

雌二醇、人绒毛膜促性腺激素及糖类抗原125与先兆流产妊娠预后的关系研究

目的:分析雌二醇(E2)、人绒毛膜促性腺激素(hCG)以及糖类抗原125(CA125)与先兆流产妊娠预后之间的关系。方法:选择100例先兆流产妊娠患者进行研究,按照妊娠结局分为继续妊娠组60例和妊娠失败组40例,并选择50例健康早孕妇女作为对照组。检测三组的E2、hCG以及CA125水平,并比较分析各监测指标的意义。结果:继续妊娠组和对照组的E2、hCG水平显著高于妊娠失败组,差异均有统计学意义(P<0.05);妊娠失败组的CA125水平显著高于继续妊娠组和对照组,差异均有统计学意义(P<0.05)。结论:先兆流产妊娠患者的E2、hCG以及CA125水平与妊娠预后之间存在较大的关系。联合检测各项指标,对于早期正确评估先兆流产预后具有重要的临床意义。     

血清新型细胞角蛋白联合肿瘤标志物检测在非小细胞肺癌诊断中的应用

目的:探讨血清新型细胞角蛋白标志物Monototal联合其他肿瘤标志物在非小细胞肺癌诊断的临床价值。方法:检测非小细胞肺癌患者126例(肺鳞癌67例、肺腺癌59例,非小细胞肺癌组)、肺部良性疾病患者68例(肺部良性疾病组)和健康人群45例(健康对照组)血清中细胞角蛋白19片段(CYFRA21-1)、糖类抗原153(CA153)、神经元特异烯醇化酶(NSE)及新型细胞角蛋白标志物Monototal水平,并统计分析其敏感性和特异性。结果:非小细胞肺癌组血清CYFRA21-1、CA153、NSE及Monototal水平均显著高于肺部良性疾病组及健康对照组,比较差异均有统计学意义(P<0.05);非小细胞肺癌组血清CYFRA21-1、CA153、NSE及Monototal阳性率显著高于肺部良性疾病组及健康对照组,比较差异均有统计学意义(P<0.05),敏感性分别为66.7%、32.5%、40.4%及77.8%;各项肿瘤标志物单检对非小细胞肺癌诊断的灵敏度分别为66.7%、32.5%、40.4%和77.8%,4项指标联合检测的敏感性为89.7%,显著高于单项检测指标,比较差异均有统计学意义(P<0.05)。结论:Monototal联合CYFRA21-1、CA153、NSE检测能提高非小细胞肺癌诊断的灵敏性。     

酒精性肝病患者血清CA125检测结果分析

目的分析酒精性肝病患者血清CA125的水平变化,探讨血清CA125在酒精性肝病中的应用价值。方法本文共收集肝病患者96例,将其分为非酒精性脂肪肝组24例,酒精性脂肪肝组10例,肝炎后肝硬化组37例和酒精性肝硬化组25例,另22例健康体检者作为健康对照组,测定各组血清CA125的水平。结果酒精性脂肪肝组、肝炎后肝硬化组和酒精性肝硬化组CA125水平均明显高于健康对照组(P<0.05),CA125异常的病例数及百分数也明显高于健康对照组,酒精性脂肪肝组CA125水平高于非酒精性脂肪肝组(P<0.05)。非酒精性脂肪肝组与健康对照组,酒精性肝硬化组与肝炎后肝硬化组间CA125水平差异均无显著性(P>0.05)。结论血清CA125在酒精性肝病患者中随着肝脏病变的加重有不同程度的改变,早期酒精性脂肪肝时CA125已呈现升高趋势,CA125在酒精性肝病诊治及预后中具有一定的临床应用价值。     

学看化验单(九)——怕得癌 检查哪些指标

<正>肿瘤标志物的合理应用及注意事项肿瘤标志物在癌症的早期诊断中发挥着重要的预警作用,但在临床上不能过于依赖,要注意合理应用。常见肿瘤的首选标志物及补充标志物列表见表1。例1:张女士,因子宫内实质性占位病变就诊,实验室检测甲胎蛋白正常,癌胚抗原正常,糖类抗原125正常,糖类抗原19-9的检则值是65.3单位/毫升。我们知道糖类抗原19-9是胰腺癌、胆管癌的诊断和鉴别指标。80%～90%胰腺癌的患者血中糖类抗原19-9明显升高。肝癌、胃癌、食管癌、部分胆管癌的患者亦可见增高,术前糖类抗原19-9水平与预后有关。正常参考值:0～39单位/毫升,从升高的水平     

癌抗原125、癌抗原199及骨桥蛋白联合检测对卵巢上皮癌的诊断价值

目的：探讨癌抗原125、癌抗原199及骨桥蛋白联合检测对卵巢上皮癌（EOC）的诊断价值。方法选择2010年6月至2012年5月在苏州市立医院住院治疗的 EOC 患者（EOC 组）40例、卵巢上皮良性肿瘤患者（BEOT组）40例及门诊体检的健康女性（对照组）40例。检测 EOC 组、BEOT 组治疗前后和对照组血清癌抗原125、癌抗原199及骨桥蛋白水平。评价血清癌抗原125、癌抗原199和骨桥蛋白单独检测及三者联合检测的方法学指标对EOC 的诊断价值。结果EOC 组治疗后与治疗前各指标比较差异有统计学意义（P ＜0．05）;治疗后血清癌抗原125、癌抗原199及骨桥蛋白水平 EOC 组明显高于对照组、BEOT 组,EOC Ⅲ期、EOC Ⅳ期均明显高于 EOCⅠ期、EOC Ⅱ期（均 P ＜0．05）,而对照组与 BEOT 组比较差异无统计学意义（P ＞0．05）;血清癌抗原125、癌抗原199及骨桥蛋白三者联合检测的敏感性较单独检测大幅提高（P ＜0．05）;骨桥蛋白＋癌抗原125联合检测可提高对浆液性 EOC 的检出率（85．0％）,骨桥蛋白＋癌抗原199联合检测可提高对黏液性 EOC 的检出率（87．5％）,三者联合检测对黏液性 EOC 及浆液性 EOC 的检出率均高于单独检测及2种方法联合检测（均 P ＜0．05）。结论血清癌抗原125、癌抗原199及骨桥蛋白三者联合检测对 EOC 具有较高的诊断价值。     

Humoral immune response to Bacteroides gingivalis fimbrial antigen in mice

Bacteroides gingivalis fimbrial antigen incorporated into liposomes, but not in Tris-HCl buffer, significantly raised the levels of anti-fimbriae antibodies in serum, particularly of the IgG class, after oral primary and booster immunizations in BALB/c mice. An approximately linear relationship was observed between the dose of fimbrial antigen and the level of fimbriae-specific antibodies produced; antibody production reached its maximum at an immunization dosage of 500 micrograms of fimbriae per mouse. Fimbriae-specific antibody production was enhanced by use of a semi-synthetic adjuvant, a stearoyl derivative of sodium beta-N-acetylglucosaminyl-(1----4)-N-acetylmuramyl-L-alanyl-D-isoglutaminyl-(L) - stearoyl-(D)-meso-diamino-pimelic acid-(D)-amide-D-alanine (GM)-53) in liposomes. High anti-fimbriae antibody levels in serum and saliva were maintained for several months in the mice that had received two orally administered boosters of fimbrial antigen with GM-53 in liposomes. Salivary anti-fimbriae antibody levels, particularly of the IgA class, were markedly raised.     

The effect of home characteristics on dust antigen concentrations and loads in homes

On-site home visits, consisting of a home inspection, dust sampling, and questionnaires were conducted in 777 homes belonging to an ongoing birth cohort study in Cincinnati, Ohio. Various home characteristics were investigated, and antigen levels (concentrations [microg/g] and loadings [microg/m(2)]; IU for cockroach allergen) in floor dust samples collected in child's primary activity room were analyzed by ELISA. Monoclonal antibodies were used for the analysis of cat, house dust mite, and cockroach allergens, and polyclonal antibodies for Alternaria and dog antigens. The relationship between the antigen levels and home characteristics was investigated through a generalized multiple regression model. More than half of the homes experienced mold/water damage. Cats and dogs were present in 19.7% and 31.1% of homes, respectively. More than 90% of homes had either carpet or area rug covering their floors. Among 777 homes, 87-92% of homes had measurable amount of Alternaria, cat, and dog allergen/antigen in house dust, whereas only 38% and 14% of homes had measurable levels of house dust mite and cockroach, respectively. Alternaria antigen level in house dust was not associated with visual mold/water damage, which was suspected to be one of the sources for this antigen in homes. Instead, the antigen level was high in samples taken in fall and in homes having dogs implicating that Alternaria antigen appears to be transported from outdoors to indoors. A high level was also measured in homes using a dehumidifier (these homes have experienced excessive humidity) and in-home venting of clothes dryer, which might be associated with microclimate affecting mold growth and spore release. The allergen/antigen level (both concentration and loading) of cat, dog and cockroach was significantly associated with the number of cats and dogs, or the appearance of cockroaches, respectively. High level of house dust mite allergen was measured in bedrooms and in homes using dehumidifier and no central forced air heating system. Having indoor plants was shown to reduce allergen levels. Carpeted floor was found to hold larger amount of antigens than non-carpeted floor. Antigen loading demonstrated more consistent and larger numbers of associations with home characteristics compared to antigen concentration. This study encompassed a wide range of home characteristics and various antigen types. Our findings provide information on home characteristics that can be used for allergen avoidance and in planning future exposure assessment studies.     

感染依赖性抗原Tp0470的鉴定及在梅毒诊断中的应用

为筛选新型梅毒诊断抗原,以改进梅毒早期诊断及预后判断血清学诊断方法,本研究在鉴定Tp0470蛋白为感染依赖性抗原的基础上,建立基于Tp0470的ELISA方法,检测468份临床血清标本,并与TPPA、LZELISA及RPR结果比较,初步评价该蛋白的诊断价值;同时对Tp0470-ELISA A_(450)值与RPR滴度进行相关性分析。结果显示:Tp0470-ELISA的灵敏度和特异度分别为95. 32%和95. 66%,ROC分析其AUC值为0. 907。与TPPA、LZELISA及RPR结果相比,Tp0470-ELISA的符合率分别为95. 51%(kappa=0. 907)、94. 87%(kappa=0. 897)、88. 67%(kappa=0. 771)。Tp0470-ELISA的A_(450)值与RPR滴度的相关系数为0. 38,P=0. 96。以上结果表明基于Tp0470蛋白的ELISA在梅毒血清学诊断中具有较高的潜在应用价值。     

Monoclonal antibodies to human growth hormone induce an allosteric conformational change in the antigen

We re-investigated the properties of a monoclonal antibody (mAb), 4D11, to human growth hormone (hGH) that showed a very weak affinity, recognizing hGH only when the hormone was solubilized on a solid surface. MAb4D11 did not significantly bind 125I-hGH. It was found that three mAb directed to different hGH epitopes (mAb 3C11, 10C1 and NA71) were able to induce the binding of the soluble antigen to mAb 4D11. The co-operative effect could be demonstrated by the formation of binary complexes (Ag:Ab, 1:2) detected by high-performance liquid chromatography (HPLC) and by the increase of radioactivity found when the synergistic mAb were added to 125I-hGH incubated with mAb 4D11 immobilized on polyvinyl microplates. Other possible explanations, such as the formation of cyclic complexes or the generation of a new epitope in the Fc fragment of the first antibody (Ab), were dismissed because the Fab fragment of one of the enhancing mAb (3C11) gave the same effect as the intact Ab. The data suggest that the hGH molecule undergoes a localized conformational change after binding to mAb 3C11, NA71 or 10C1 and that mAb 4D11 binds with high affinity to the modified region of the hormone. The formation or not of ternary complexes (Ag:Ab, 1:3) was used to localize the 4D11 epitope on the surface of the Ag. It is suggested that mAb 4D11 recognizes a conformational change produced in the region defined by the AE5/AC8 epitopes, which is close to the hGH antigenic domain only expressed when the protein is immobilized on plastic surfaces.