肿瘤相关抗原指标在慢性乙型肝炎中的临床意义

吴寅涛+周玉麟+杨志贤

【摘要】目的探讨肿瘤相关抗原指标在慢性乙型肝炎中的临床意义。

方法选取感染科住院治疗的乙型病毒性肝炎患者80例，按有无黄疸分为两组（无黄疸组与黄疸组），所有患者分别检测入院时及出院前清晨空腹血清中肿瘤相关抗原指标：甲胎蛋白（AFP）、癌胚抗原（CEA）、糖链抗原199（CA199）、糖链抗原125（CA125）。

结果入院时无黄疸组与黄疸组间CEA比较差异无统计学意义（P>005）；AFP、CA199、CA125比较差异有统计学意义（P<001）。出院前无黄疸组与黄疸组间CEA比较差异无统计学意义（P>005）；AFP、CA199、CA125比较差异有统计学意义（P<001）。黄疸组入院时与出院前CEA比较，差异无统计学意义（P>005），AFP、CA199、CA125比较差异有统计学意义（P<001）。无黄疸组入院时与出院前AFP比较差异有统计学意义（P<005），CEA、CA199、CA125比较差异均无统计学意义（P>005）。

结论 CEA在慢性乙肝患者中一般无明显异常。慢性乙肝患者如出现AFP、CA199、CA125异常增高，应积极作影像学检查或内镜检查排除肿瘤，通常这些异常指标随肝炎病情好转而明显降低。CA199、CA125异常增高常见于伴有黄疸的慢性乙肝患者。

【关键词】肝炎；乙型；AFP；CEA；CA199；CA125

中图分类号：R512.6+2文献标识码：ADOI：10.3969/j.issn.10031383.2014.05.015【Abstract】ObjectiveTo study the clinical significance of tumorassociated antigen indexes in patients with chronic hepatitis B.

Methods80 patients，who were infected with hepatitis B virus and hospitalized in Department of Infection of our hospital，were selected and all the patients were divided into observation group（with jaundice） and control group （without jaundice）.Tumorassociated antigen indexes in the serum of all the patients were detected on admission and in the morning of before hospital discharge respectively when they were on empty stomach.The indexes included alpha fetoprotein （AFP），carcinoembryonicantigen（CEA），carbohydrate antigen199 （CA199） and carbohydrate antigen125（CA125）.

Results Difference of CEA value on admission between the two groups was not statistically significant（P>005），but differences of AFP，CA199 and CA125 values between two groups were statistically significant（P<001）.There was also no statistic significance in CEA value difference between two groups before hospital discharge（P>005），but differences of AFP， CA199 and CA125 values between these two groups were statistically significant（P<001）. In the observation group，difference of CEA levels on admission and before hospital discharge was not statistically significant（P>005），but there were great statistical difference of AFP，CA199 and CA125 values between the above two points of time（P<001）.In the control group，AFP value difference had statistical significance on admission and before hospital discharge（P<005），but no significant difference was found in CEA，CA199 and CA125 values between the two time points（P>005）.

ConclusionIn general，CEA in patients with chronic hepatitis B shows no obvious abnormality.If AFP，CA199 and CA125 are found abnormally high，imaging examination or endoscopic examination should be conducted to detect the tumor.Usually these abnormal indexes obviously decrease with the improvement of hepatitis.Abnormally high levels of CA199 and CA125 usually exist in chronic hepatitis B patients with jaundice.

【Key words】hepatitis；type B；alpha fetoprotein；carcinoembryonic antigen；carbohydrate antigen199；carbohydrate antigen125

临床工作中经常遇到部分慢性乙肝患者在治疗过程中检测到甲胎蛋白（AFP）、癌胚抗原（CEA）、糖链抗原199（CA199）、糖链抗原125（CA125）中的部分指标异常升高的情况，根据临床实践经验，其中大部分患者均无肿瘤发生，这些异常的肿瘤相关抗原指标大多随肝炎病情好转而呈现正常化趋势。笔者就此问题作一观察总结，使医患双方能更加客观地看待异常肿瘤相关抗原指标的临床意义，既能警惕肿瘤指标异常所表示的肿瘤发生预警信号，又不必因过分担忧而影响预后。……