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目的探讨结直肠癌患者血清抗-癌胚抗原(CEA)特异性抗体的存在情况及其临床意义。方法随机选取69例初治、无免疫系统疾病、资料完整的结直肠癌病例分为观察组,对照组为28例良性肠道疾病患者和37例健康体检者。所有病例治疗前检测血清CEA(ECLIA)、IgG、IgA、IgM(免疫透视比浊法定量测定)、抗-CEA抗体(间接-ELISA法),免疫组化(LSAB)检测肿瘤组织CEA。用竞争抑制法检测抗体的特异性。结果结直肠癌患者血清CEA含量升高者(≥5ng/mL)为37.7%(26/69),抗-CEA(IgG或IgM)抗体阳性者为63.8%(44/69),两者联合检测阳性率升至84.0%(58/69)。良性肠道疾病患者和健康体检者无血清CEA升高者,血清抗-CEA抗体阳性者分别为10.7%(3/28)、10.8%(4/37)。血清抗-CEA抗体与血清CEA、淋巴结转移、Dukes’分期和免疫球蛋白含量有显著相关关系(P<0.05)。抗-CEA抗体阳性与阴性患者的5年生存率差异有显著性(P<0.05)。结论结直肠癌患者血中存在抗-CEA抗体,是一种比CEA更敏感的肿瘤标记物。它作为肿瘤标记物和预后因素有待在进一步的大型多中心随机临床研究证实。
Objective To investigate the presence and clinical significance of serum anti-carcinoembryonic antigen (CEA) -based antibodies in patients with colorectal cancer. Methods Totally 69 cases of newly diagnosed and non-immune system diseases were selected randomly. The data of complete colorectal cancer were divided into observation group and control group with 28 cases of benign intestinal diseases and 37 cases of healthy subjects. All cases before treatment, serum CEA (ECLIA), IgG, IgA, IgM (quantitative immunohistochemical assay), anti-CEA antibody (indirect ELISA), immunohistochemistry (LSAB) detection of tumor tissue CEA. Antibody specificity was measured by competitive inhibition. Results The serum levels of CEA in patients with colorectal cancer were 37.7% (26/69), and 63.8% (44/69) were positive for anti-CEA (IgG or IgM) antibody. The positive rate rose to 84.0% (58/69). Patients with benign bowel disease and healthy people with elevated serum CEA, serum anti-CEA antibody positive were 10.7% (3/28), 10.8% (4/37). Serum anti-CEA antibody and serum CEA, lymph node metastasis, Dukes’ stage and immunoglobulin content was significantly correlated (P <0.05). The 5-year survival rate of anti-CEA positive and negative patients was significantly different (P <0.05). Conclusion The presence of anti-CEA antibody in the blood of colorectal cancer patients is a more sensitive tumor marker than CEA. Its use as a tumor marker and prognostic factor remains to be confirmed in further large multicenter randomized clinical studies.