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1、 与临床表现不符的血清异常升高例及原因分析 张文王怀连【摘要】 糖抗原(carbohydrate antigen, CA) 19-9是一种同结直肠癌细胞株免疫小鼠所获抗体结合的抗原。肿瘤标志物(tumor marker)是反映肿瘤存在的化学类物质。它们不存在于正常成人组织而仅见于胚胎组织,或在肿瘤组织中的含量大大超过在正常组织里的含量,它们的存在或量变可以提示肿瘤的性质,借以了解肿瘤的组织发生、细胞分化、细胞功能,以帮助肿瘤的诊断、分类、预后判断以及治疗指导。在胰腺癌,胆囊癌,胆管癌患者血清中CA19-9显著升高,因此在临床上作为胆胰系统肿瘤的标志物被广为使用。但是亦有因服用胃黏膜保护剂或胆胰
2、炎性反应等导致CA19-9假阳性的报道。本文1例与临床表现严重不符的血清CA19-9升高的病例,在此做一报道,并对假阳性的原因作了分析。【关键词】 CA19-9;异常升高Inconsistent with the clinical manifestations of abnormal increase of seram CA19-9 and cause analysis 1 caseZHANG Wen,WANG Huai-lian.Dalian City Maternity Hospital,Liaoning 116021,China【Abstract】 Objective Carbohydr
3、ate antigen (CA) 19-9 is a kind of antigen which link to antibody aquired by mouse immunized with colon and rectal cancer cell strains. Tumor marker is a kind of chemical matter reflect tumor existence. They dont exist normal adult tissue but embryonal tissue either, or their contents in tumor tissu
4、e exceed nomal tissue extremely. Their exsistence or quantitative change maybe present tumor quality to realize occurrence of tumor tissue, cells differentiation, and cells function, which can help the diagnosis , classification, prognosis and therapic instruction of tumor. Level of CA19-9 rises in
5、patients serum of pancreatic cancer, gallbladder cancer and cholangiocarcinoma, so it is used widely as marker of pancreatic and gallbladder system clinically. Nevertheless, it was reported that taking mucosal protective agent or pancreatic and gallbladder inflammation and so on could induce false p
6、ositive of CA19-9. The author find out a case of CA19-9 levels rise which doest accord with clinical represention extremely, report as follows and analyse the reason of false positive.【Key words】 CA19-9;Rise abnormally1 临床资料患者女,52岁,丙型肝炎病毒阳性,因血清中CA19-9异常升高而被疑为胰腺癌。其他肿瘤标志物检测值均在正常范围,腹部超声,CT等影像学检查均未见明显肿瘤
7、。2 CA19-9的检测采用化学发光酶免疫测定法(chemiluminescent enzyme immunoassay, CLEIA),固相为鼠抗人CA19-9抗体结合微粒,标记抗体为碱性磷酸酶标记的鼠抗人CA19-9抗体。正常值在37IU/ml以下。3 假阳性原因的解析稀释线性的探讨,倍比稀释后检测值如表1所示。稀释后测定值明显呈非线性分布,因此笔者怀疑这可能是由于患者体内存在嗜异种抗体(heterophile antibody, hAb)所导致的非特异性反应所致,因此笔者加入PEG(polythylene glycol)处理后,对离心所获上清(不含抗体成分)和沉淀分别进行CA19-9的测
8、定,结果如表2。上清稀释后测定值呈线性分布,我们推断该患者实际CA19-9值为45IU/ml。而含抗体的沉淀部分稀释后测定值依然不呈线性分布。4 讨论近年,免疫测定法广泛应用于肿瘤标志物等体内微量物质的测定中,CA19-9升高见于 大部分胰腺癌患者血清CA19-9水平明显增高肝胆系癌、胃癌、结直肠癌的CA19-9水平也会升高,低浓度增高、一过性增高可见于慢性胰腺炎、胆石症、肝硬化、肾功能不全、糖尿病等。但是有一部分患者血清中存在的嗜异种抗体可以直接与检测抗体或固相支持物结合,导致非特异反应1,人抗鼠抗体就是其中之一。本文病例,可能就是患者体内的人抗鼠抗体直接与固相支持物或标记抗体结合,导致CA
9、19-9假性升高。在日常工作中,如果存在嗜异种抗体稀释后的测定值会偏离线性分布,而且PEG处理可以明确嗜异种抗体的存在。因此需时刻铭记免疫测定时可能引起非特异反应,对测定的原理,使用试剂的特性有充分的理解十分必要。参考文献1 周国中.胰腺癌发生相关因素及与预后关系的研.第二军医大学,2002.2 闫慧.肿瘤标志物CEA CA19-9,CA242 Ferritin对胰腺癌诊断的意义. 长治医学院院报,2005,4.3 Boscato LM, Stuart MC. Incidence and specificity of interference in two-site immunoassays. Clin Chem, 1986,32:1491-1495. -全文完-