Department of Clinical Biochemistry, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2013 Jan;126(2):274-9.
Serum tumor markers have always been of clinical importance in the diagnosis, monitoring disease progression and therapy efficacy for patients with malignant diseases. However, elevated serum tumor markers are found in some benign conditions, especially in chronic kidney disease (CKD). The elevation of them in CKD might cause confusion and misuse of these tumor markers. We conducted this retrospective study to investigate which of the five widely used tumor markers including carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), cytokeratin 19 fragment antigen 21-1 (Cyfra21-1), squamous cell carcinoma antigen (SCC) and neuron specific enolase (NSE) are affected markedly by CKD, in order to use them more effectively.
Serum tumor marker concentrations, biochemical, hematological parameters, and urinalysis were measured in CKD patients and healthy controls. The positive rate and median tumor markers' level in CKD patients and controls, and those in CKD patients stratified by CKD grade were compared using nonparametric rank tests. Correlation analysis of serum tumor markers and other parameters in CKD patients were performed using the Spearman correlation coefficient. Multivariate Logistic regression analysis was used to estimate the important variables that caused elevated serum concentrations of these markers in CKD patients.
The overall positive rates and serum concentrations of Cyfra21-1, SCC, CEA in CKD group were significantly higher than those in control group. Positive rate and serum concentrations of those tumor markers increased as kidney function decreased. Both univariate analysis and multivariate regression analysis showed that the elevations of those tumor markers were not only associated with kidney function, but also with nutritional status.
Serum concentrations of Cyfra21-1, SCC, CEA are significantly influenced by kidney function, as well as nutritional status. Therefore, in clinical work, the indices of kidney function and nutritional status could be simultaneously measured to improve interpretation of the results of those tumor marker concentrations.
血清肿瘤标志物在恶性疾病患者的诊断、监测疾病进展和治疗效果方面一直具有重要的临床意义。然而，一些良性疾病，尤其是慢性肾脏病（CKD），也会导致血清肿瘤标志物升高。这些标志物在 CKD 中的升高可能会导致混淆和误用这些肿瘤标志物。我们进行了这项回顾性研究，以调查包括癌胚抗原（CEA）、甲胎蛋白（AFP）、细胞角蛋白 19 片段抗原 21-1（Cyfra21-1）、鳞状细胞癌抗原（SCC）和神经元特异性烯醇化酶（NSE）在内的五种常用肿瘤标志物中哪些受 CKD 影响显著，以便更有效地使用它们。
测量 CKD 患者和健康对照者的血清肿瘤标志物浓度、生化、血液学参数和尿液分析。使用非参数秩检验比较 CKD 患者和对照组的阳性率和中位数肿瘤标志物水平，以及 CKD 分级分层的 CKD 患者的中位数肿瘤标志物水平。采用 Spearman 相关系数分析 CKD 患者血清肿瘤标志物与其他参数的相关性。采用多元 Logistic 回归分析估计导致 CKD 患者血清标志物浓度升高的重要变量。
CKD 组的 Cyfra21-1、SCC、CEA 的总阳性率和血清浓度明显高于对照组。随着肾功能的下降，这些肿瘤标志物的阳性率和血清浓度均升高。单因素分析和多元回归分析均表明，这些肿瘤标志物的升高不仅与肾功能有关，还与营养状况有关。
血清 Cyfra21-1、SCC、CEA 浓度受肾功能和营养状况的显著影响。因此，在临床工作中，同时测量肾功能和营养状况的指标，可以提高对这些肿瘤标志物浓度结果的解释。
