血液检验中的肿瘤标志物能查出癌症吗？
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">咱们</span>在体检<span style="color: black;">或</span>看病时，<span style="color: black;">大夫</span>常会<span style="color: black;">按照</span><span style="color: black;">病人</span>的<span style="color: black;">自己</span>需求或病情<span style="color: black;">选取</span>相应的肿瘤标志物（简<span style="color: black;">叫作</span>“肿标”）进行检验，<span style="color: black;">那样</span>，肿标的检验能查出癌症吗？！</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">首要</span>，什么是肿瘤标志物呢？</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肿瘤标志物是肿瘤在<span style="color: black;">出现</span>和增殖过程中，由肿瘤细胞本身合成、释放或由机体对肿瘤细胞反应而产生的标志肿瘤存在和生长的一类物质。肿瘤标志物存在于<span style="color: black;">病人</span>的血液、体液、细胞或组织中，可用生物化学、免疫学及分子生物学等<span style="color: black;">办法</span>进行测定。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">那样</span>，<span style="color: black;">为何</span>要进行肿瘤标志物的<span style="color: black;">检测</span>呢？</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">01</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">用于肿瘤或可疑肿瘤的辅助诊断。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">02</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">用于确诊肿瘤<span style="color: black;">病人</span>的治疗监测、预后<span style="color: black;">评定</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">03</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">用于特定人群的肿瘤筛查。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">肿瘤标志物都有<span style="color: black;">那些</span>呢？</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肿瘤标志物大致分为五类：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">01</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胚胎类抗原类：癌胚抗原（CEA）、甲胎蛋白（AFP）等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">02</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">糖类糖蛋白抗原类：糖链抗原19-9（CA19-9）、CA125、CA153、CA724、鳞状细胞癌抗原（SCC）、细胞角蛋白19片段（CYFRA21–1）等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">03</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">酶及蛋白类：前列腺特异性抗原（PSA）、神经元特异性烯醇化酶（NSE）等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">04</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">激素类：人绒毛膜促性腺激素（HCG）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">05</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">循环核酸类：循环肿瘤细胞（CTC）、循环肿瘤DNA（ctDNA）、微小RNA（ｍiRNA）等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">肿瘤标志物<span style="color: black;">反常</span><span style="color: black;">表率</span>什么<span style="color: black;">道理</span>呢？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲胎蛋白（AFP）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">是辅助诊断原发性肝细胞癌（HCC）常用的肿标，当AFP>200µg/L提示<span style="color: black;">身患</span>HCC，当AFP>400µg/L时<span style="color: black;">剧烈</span>提示HCC。但有<span style="color: black;">科研</span><span style="color: black;">表示</span>，AFP在HCC的阳性率<span style="color: black;">通常</span>为70%<span style="color: black;">上下</span>，有约30%的HCC<span style="color: black;">病人</span>AFP不<span style="color: black;">上升</span>，<span style="color: black;">因此呢</span>，<span style="color: black;">不可</span>仅靠AFP来诊断肝癌。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌胚抗原（CEA）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">是一种较广谱的肿标，临床可用于结直肠癌、肺癌、乳腺癌、消化道肿瘤等的辅助诊断，但CEA在妊娠、结肠炎、结肠息肉、胰腺炎、肝硬化、肝炎、肺部良性<span style="color: black;">疾患</span>和心血管<span style="color: black;">疾患</span>等，<span style="color: black;">亦</span>可有不同程度的<span style="color: black;">上升</span>，临床需<span style="color: black;">重视</span>鉴别，避免误诊。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CA19-9</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">是胃肠道肿瘤<span style="color: black;">关联</span>的肿瘤标志物，常用于结直肠癌、胃癌、胰腺癌和胆囊癌的辅助诊断，是迄今<span style="color: black;">报告</span>过的对胰腺癌<span style="color: black;">敏锐</span>性最高的标志物，对胰腺癌的筛查、判断肿瘤复发及预后均<span style="color: black;">拥有</span><span style="color: black;">要紧</span>的<span style="color: black;">功效</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CA125</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">属于卵巢癌<span style="color: black;">关联</span>抗原，对上皮性卵巢癌，特别是浆液性腺癌的<span style="color: black;">敏锐</span>性较高，约80％的<span style="color: black;">病人</span>CA125<span style="color: black;">上升</span>，但对黏液性卵巢癌<span style="color: black;">敏锐</span>性较低。CA125<span style="color: black;">能够</span>在症状<span style="color: black;">显现</span>前几个月<span style="color: black;">上升</span>，在卵巢癌的筛查、<span style="color: black;">初期</span>诊断以及监测肿瘤复发方面有<span style="color: black;">要紧</span><span style="color: black;">功效</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CA153</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">属于乳腺癌<span style="color: black;">关联</span>抗原，对乳腺癌<span style="color: black;">病人</span>随诊有<span style="color: black;">必定</span><span style="color: black;">道理</span>，<span style="color: black;">重点</span>用于治疗后监测乳腺癌<span style="color: black;">病人</span>的<span style="color: black;">疾患</span>复发和转移。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">CYFRA21–1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">平常</span>于肺癌中，<span style="color: black;">重点</span>用于非小细胞肺癌的辅助诊断、治疗及预后随访。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">NSE</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重点</span>存在于神经内分泌细胞及神经源性肿瘤细胞中，<span style="color: black;">做为</span>小细胞肺癌诊断的辅助指标，对小细胞肺癌诊断<span style="color: black;">拥有</span><span style="color: black;">要紧</span>价值。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">PSA</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">是与前列腺<span style="color: black;">关联</span>的一种抗原，<span style="color: black;">重点</span>用于前列腺癌的<span style="color: black;">初期</span>诊断、病情监测及治疗后随访。PSA可出<span style="color: black;">此刻</span>正常的、良性增生的或恶性前列腺组织中。临床上<span style="color: black;">经过</span>计算游离PSA与总PSA比值<span style="color: black;">能够</span><span style="color: black;">加强</span>筛查和诊断前列腺癌的特异性。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">HCG</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">是由于</span>胎盘滋养层细胞所分泌的一类糖蛋白类激素。对妇科肿瘤<span style="color: black;">拥有</span>较高的特异性诊断价值。HCG常用于胎盘滋养细胞和生殖细胞肿瘤的诊断或辅助诊断，<span style="color: black;">亦</span>可用于乳腺癌的诊断。<span style="color: black;">同期</span>正常妊娠<span style="color: black;">初期</span><span style="color: black;">亦</span>会<span style="color: black;">显现</span>HCG的<span style="color: black;">上升</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">循环肿瘤细胞（CTC）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">指的是</span>存在于外周血循环中的肿瘤细胞。与传统肿瘤标志物检测相比, CTC<span style="color: black;">做为</span>基因水平的检测, <span style="color: black;">拥有</span><span style="color: black;">敏锐</span>性高、特异性强的特点。<span style="color: black;">同期</span>其标本<span style="color: black;">源自</span>方便、<span style="color: black;">没</span>创, 可进行动态检测, 在肿瘤易感性预测、<span style="color: black;">初期</span>诊断、监测疗效、预测复发转移等方面<span style="color: black;">拥有</span><span style="color: black;">要紧</span>的临床价值, 为肿瘤基因诊断开辟了新的途径。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">那样</span>，</span><span style="color: black;"><strong style="color: blue;"><span style="color: black;">体检报告<span style="color: black;">表示</span>肿瘤标志物<span style="color: black;">上升</span>了，就<span style="color: black;">寓意</span>着得肿瘤了吗？<span style="color: black;">或</span>是某一种肿瘤标志物的<span style="color: black;">反常</span>，就提示<span style="color: black;">必定</span>得了某一种肿瘤了吗？</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这两种观点都是不正确的。<span style="color: black;">首要</span>，部分正常组织<span style="color: black;">或</span>良性的非肿瘤性的<span style="color: black;">疾患</span>，<span style="color: black;">例如</span>说妊娠、炎症、溃疡、息肉等，<span style="color: black;">亦</span>可<span style="color: black;">导致</span>肿瘤标志物的<span style="color: black;">升高</span>，并不<span style="color: black;">寓意</span>着得了肿瘤。<span style="color: black;">因此呢</span>单纯的<span style="color: black;">经过</span>肿瘤标志物的<span style="color: black;">反常</span>是<span style="color: black;">不可</span>诊断肿瘤的。其次，实际上在临床上绝大<span style="color: black;">都数</span>肿瘤标志物特异性并不强，<span style="color: black;">亦</span><span style="color: black;">便是</span>说<span style="color: black;">不可</span><span style="color: black;">按照</span>某一种肿瘤标志物<span style="color: black;">反常</span>，就认为得了某一种肿瘤。<span style="color: black;">例如</span>临床上应用的最广泛的肿瘤标志物癌胚抗原（CEA），可见于肺癌、乳腺癌、甲状腺癌、肝癌等肿瘤；但<span style="color: black;">亦</span>有某些肿瘤标志物的特异性较强，如前列腺特异抗原（PSA），<span style="color: black;">因此</span><span style="color: black;">不可</span>单纯<span style="color: black;">按照</span>某一种肿瘤标志物的<span style="color: black;">升高</span>就判定得了某一种肿瘤，<span style="color: black;">必要</span>结合<span style="color: black;">病人</span>的病史、临床表现、影像学<span style="color: black;">检测</span>、组织病理等来<span style="color: black;">一起</span>诊断，其中<strong style="color: blue;">病理诊断是诊断肿瘤的金标准。</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_png/fTb2ib36Ybo9y3IcgxazxRjUdBfmdic82CynUjLdpB5artmXrZ6qhAtHq30WaV0sicPCWBfAIE0wemjW9eIyPgFkg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>，针对不同的病变部位，肿瘤标志物的结果有不同组合和应用意见，<span style="color: black;">详细</span>的<span style="color: black;">状况</span>还请您到专科医院或肿瘤科门诊咨询。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">■</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考资料：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 巩晓瑞,马锐.肿瘤标志物的临床<span style="color: black;">道理</span>及<span style="color: black;">科研</span><span style="color: black;">发展</span>.医学与哲学(B),2018,39(12):48-52.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> 李林海.<span style="color: black;">平常</span>肿瘤标志物的临床应用及<span style="color: black;">发展</span>.中华检验医学杂志,2016,39(12):995-998.</p><img src="https://mmbiz.qpic.cn/mmbiz_png/fTb2ib36Ybo9y3IcgxazxRjUdBfmdic82CXduKcT5ISBJ4ENDzEWLAq28lMRziciaUiaRpCAmbzeoXx06JK4TfwMP3A/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">微X</span>号</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">13167399097</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">头条号</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">中医肿瘤<span style="color: black;">大夫</span></strong></p>
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