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如何正确解读肿瘤标志物检测结果?

2017-07-22 佚名 转化医学网

肿瘤标志物检测从医学诊断的角度来说,它不是肿瘤诊断的金标准,而应理解为只是一种筛查手段。要确定是否是肿瘤,还要结合其他检查手段,比如CT、超声、脱落细胞学、组织病理检测等综合考虑。组织或细胞病理学依据才是确诊肿瘤的金标准。某些肿瘤标志物在某些生理情况下或良性疾病也可以异常升高。比如,肝炎时,可导致CA199升高;肠炎时,可导致AFP升高;长期抽烟,可影响CEA和CA125的水平等等。所以,肿瘤标志

肿瘤标志物检测从医学诊断的角度来说,它不是肿瘤诊断的金标准,而应理解为只是一种筛查手段。要确定是否是肿瘤,还要结合其他检查手段,比如CT、超声、脱落细胞学、组织病理检测等综合考虑。组织或细胞病理学依据才是确诊肿瘤的金标准。某些肿瘤标志物在某些生理情况下或良性疾病也可以异常升高。比如,肝炎时,可导致CA199升高;肠炎时,可导致AFP升高;长期抽烟,可影响CEA和CA125的水平等等。所以,肿瘤标志物水平的升高除了要注意肿瘤和非肿瘤性疾病的客观鉴别,还要结合临床,如果是单纯的肿瘤标志物升高,但其他检查未发现肿瘤的证据的情况下,要考虑患者个体差异和临床具体情况进行分析,毕竟参考范围不是检验科根据自己地区的人群而设立的,而且参考范围的设定只适合95%左右的人群。

肿瘤标志物的免疫检测原理较为复杂,虽然检测的核心是抗原抗体反应,但是不同的公司生产的抗体所针对的抗原表位不同,因此检测的特异性、抗干扰能力也不同,参考范围也不一样,这也是造成检测结果不尽相同的原因之一。有时,几种方法测量的值可以相差5倍之多,尤其对于某些糖类抗原,如CA199、CA125等,所以不能做不同方法、不同仪器设备检测结果的比较。

因此,对于肿瘤标志物的正确解读,推荐以下几点:

1. 尽量使用肿瘤标志物联合检测。临床上经常检测的肿瘤标志物有十余项,即使大家普遍认为AFP对肝癌,CA125对卵巢癌,CA153对于乳腺癌等具有高的相关性,但单独检测一个指标升高不能确定就是相应的肿瘤或某一指标不高也不能说明没有相应的肿瘤,而应多种标志物同时检测,以提高敏感性和特异性。

2. 肿瘤标志物某项升高,提示需要使用相应的其它检查手段确认,比如采用CT、超声、脱落细胞学、组织病理检测等做进一步检查。如检查全阴性,请于一个月后对该项检测指标在同一家医院,用同样的检测设备做复检,比较两次检测结果的变化趋势,如有升高的趋势,要进一步关注。

3. 肿瘤标志物检测存在假阳性和假阴性,由于是筛查指标,假阳性率更高些。一次检测的升高不足以说明什么问题,需要复检和定期复检!而且升高的幅度在参考范围上限的50%其临床参考价值更大。

4. 肿瘤标志物异常者仅能看作是高危人群,而且存在较大的个体差异,确有一些特殊人群,肿瘤标志物长期略高于正常,患者无异常,物理检查也全阴性。同样,临床也常见确诊的肿瘤患者肿瘤标志物均正常的假阴性患者。

总之,我们对肿瘤标志物的结果要有客观正确的认识,化验结果只能用作临床诊疗的参考依据,不同于病理诊断结果!检验医师有责任向临床医生推广肿瘤标志物的临床应用指南,为肿瘤的早期诊断和治疗提供科学信息。

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level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Sun Jul 23 01:23:07 CST 2017, time=2017-07-23, status=1, ipAttribution=)]
    2017-07-29 1e1263e3m20(暂无匿称)

    很好,值得学习多谢分享

    0

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    2017-07-25 ylzr123

    认真学习,不断进步,把经验分享给同好。点赞了!

    0

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level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Sun Jul 23 01:23:07 CST 2017, time=2017-07-23, status=1, ipAttribution=)]
    2017-07-24 hfuym10906

    学习了学习了学习了学习了学习了

    0

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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun Jul 23 18:48:08 CST 2017, time=2017-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=225345, encodeId=8d1c22534552, content=我们对肿瘤标志物的结果要有客观正确的认识,化验结果只能用作临床诊疗的参考依据,不同于病理诊断结果!检验医师有责任向临床医生推广肿瘤标志物的临床应用指南,为肿瘤的早期诊断和治疗提供科学信息。, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Sun Jul 23 09:21:22 CST 2017, time=2017-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=225252, encodeId=da7b22525210, content=学习中, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo61WAV0ROeLAoicPxPKoKaogwLWLL8STv86qplbdOibN2YR4KxkJicqNectCXGR8gPJhGLc7yYLSdnpx4kaVXndTfu/0, createdBy=a6962042337, createdName=1391e9f2a7m, createdTime=Sun Jul 23 06:35:55 CST 2017, time=2017-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=225249, encodeId=a1ac22524992, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sun Jul 23 06:31:07 CST 2017, time=2017-07-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=225228, encodeId=0098225228a0, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Sun Jul 23 01:23:07 CST 2017, time=2017-07-23, status=1, ipAttribution=)]
    2017-07-23 虈亣靌

    不错的文章,值得学习

    0

  7. 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level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Sun Jul 23 01:23:07 CST 2017, time=2017-07-23, status=1, ipAttribution=)]
    2017-07-23 有备才能无患

    我们对肿瘤标志物的结果要有客观正确的认识,化验结果只能用作临床诊疗的参考依据,不同于病理诊断结果!检验医师有责任向临床医生推广肿瘤标志物的临床应用指南,为肿瘤的早期诊断和治疗提供科学信息。

    0

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    2017-07-23 1391e9f2a7m

    学习中

    0

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    2017-07-23 1dd8c52fm63(暂无匿称)

    学习学习

    0

  10. 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    2017-07-23 suibian2007bbb

    学习

    0

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