Ng W W, Tong K J, Tam T N, Lee S D
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1995 Jun;55(6):438-46.
Serum CA19-9, CA125 and CEA are glycoproteic tumor markers and they have been used for detecting patients with pancreatobiliary diseases in whom obstructive jaundice is common. This study was designed to investigate whether cholestasis may interfere with the clinical application of these tumor markers or not.
Radioimmunoassay for serum CA19-9, CA125 and carcinoembryonic antigen (CEA) was obtained from 86 patients with hyperbilirubinemia, including 50 patients with malignant jaundice (pancreatic carcinoma 20, biliary tract carcinoma 30) and 36 patients with benign jaundice (choledocholithiasis 33, acute cholangitis 3). Clinical follow-up for the utility of these markers on the patients with obstructive jaundice was conducted.
In patients with malignant jaundice, higher positive rates of CA19-9 (94% vs 56%, p < 0.01), CA125 (52% vs 17%, p < 0.01) and CEA (42% vs 6%, p < 0.01) than in those with benign jaundice were found. In diagnosis of malignant tumors, sensitivity was superior in CA19-9 (94%) than in CA125 (52%) and CEA (42%), but the latter two had higher specificities (83% and 95%). In malignant jaundice, elevated serum bilirubin levels were correlated with CA125 (r = 0.34, p < 0.05) but not with CA19-9 levels. In benign jaundice, serum bilirubin were correlated with CA19-9 (r = 0.58, p < 0.001) and CA125 (r = 0.45, p < 0.01) levels. The correlation between serum bilirubin and CEA levels was not significant in either group. After effective drainage, all markers decreased significantly in patients with benign jaundice but not in those with malignant diseases.
Elevated serum CA19-9, CA125 and CEA levels were observed in both benign and malignant pancreatobiliary diseases with obstructive jaundice. Longitudinal follow-up of these markers and other complementary studies are essential for diagnosis of malignant tumors when cholestasis is present.
血清CA19 - 9、CA125和癌胚抗原（CEA）是糖蛋白性肿瘤标志物，已被用于检测常伴有梗阻性黄疸的胰腺胆管疾病患者。本研究旨在调查胆汁淤积是否会干扰这些肿瘤标志物的临床应用。
对86例高胆红素血症患者进行血清CA19 - 9、CA125和癌胚抗原（CEA）的放射免疫测定，其中包括50例恶性黄疸患者（胰腺癌20例，胆管癌30例）和36例良性黄疸患者（胆总管结石33例，急性胆管炎3例）。对梗阻性黄疸患者这些标志物的效用进行临床随访。
在恶性黄疸患者中，CA19 - 9（94%对56%，p < 0.01）、CA125（52%对17%，p < 0.01）和CEA（42%对6%，p < 0.01）的阳性率高于良性黄疸患者。在恶性肿瘤诊断中，CA19 - 9的敏感性（94%）高于CA125（52%）和CEA（42%），但后两者具有更高的特异性（83%和95%）。在恶性黄疸中，血清胆红素水平升高与CA125相关（r = 0.34，p < 0.05），但与CA19 - 9水平无关。在良性黄疸中，血清胆红素与CA19 - 9（r = 0.58，p < 0.001）和CA125（r = 0.45，p < 0.01）水平相关。血清胆红素与CEA水平在两组中均无显著相关性。有效引流后，良性黄疸患者所有标志物均显著下降，而恶性疾病患者则不然。
在伴有梗阻性黄疸的良性和恶性胰腺胆管疾病中均观察到血清CA19 - 9、CA125和CEA水平升高。当存在胆汁淤积时，对这些标志物进行纵向随访及其他补充研究对恶性肿瘤的诊断至关重要。
