张嘉倩 屠文震 陈冬冬 于伶 王蕾

【摘 要】目的：分析系统性硬化症患者血清肿瘤标记物CA724、CA199、CEA水平升高的临床意义。方法：收集系统性硬化症（SSc）患者71例为SSc组，同期本院肿瘤科住院的胃癌患者39例为对照Ⅰ组（胃癌组），同期在本院消化内科住院的慢性胃炎患者72例为对照Ⅱ组（慢性胃炎组），测定各组患者的血清CA724、CA199、CEA水平，分析比较各组间血清肿瘤标记物水平间的差异及SSc组肿瘤标记物升高的影响因素。结果：SSc组有16.90%～30.99%的患者血清肿瘤标记物水平存在不同程度的升高，其中血清CA724水平升高明显，且高于同期住院慢性胃炎患者（P < 0.05）；3组血清肿瘤标记物CA724比较，差异有统计学意义（P < 0.05）；但与胃癌组比较，差异无统计学意义（P > 0.05）。血清肿瘤标记物CEA在SSc组与胃癌组比较，差异有统计学意义（P < 0.05）。血清肿瘤标记物的异常与SSc患者的Rodnan评分、红细胞沉降率、免疫球蛋白G、病程、分型（局限型、弥漫型）差异无统计学意义（P > 0.05）。结论：血清肿瘤标记物水平升高是SSc患者的常见征象，其升高可能与本病发病机制相关，尚不能完全否定与疾病活动程度无关。因此临床上对CA724、CA199、CEA水平升高除考虑胃癌外，还需考虑其他多种因素，有待进一步研究。

【关键词】 系统性硬化症；胃癌；慢性胃炎；肿瘤标记物；CA724；CA199；CEA

【ABSTRACT】Objective：To analyze the clinical significance of the increase of serum tumor markers CA724，CA199 and CEA in patients with systemic sclerosis.Methods：There are three groups in the study：the SSc group（71 cases of systemic sclerosis），the control groupⅠ or the gastric cancer group（39 cases of gastric cancer in the same hospital） and the control group Ⅱ or the chronic gastritis group（72 cases of chronic gastritis in the same hospital）.The serum levels of CA724，CA199 and CEA were measured in each group.The difference of serum tumor markers and the influencing factors of tumor markers in the SSc group were analyzed and compared.Results：The serum tumor markers levels of 16.90% ～ 30.99% patients in the SSc group increased in different degrees，among which the serum level of CA724 increased significantly，higher than that of the patients with chronic gastritis （P < 0.05）.The differences of serum tumor marker CA724 between the 3 groups were statistically significant （P < 0.05），but there was no significant difference between the 2 groups（P > 0.05） compared with that of the gastric cancer group.The difference of serum tumor marker CEA between the SSc group and the gastric cancer group was statistically significant （P < 0.05）.Abnormalities of serum tumor markers and the differences of Rodnan score，erythrocyte sedimentation rate，IgG，course of disease，classification （localized type or diffuse type） in the SSc group were not statistically significant （P > 0.05）.Conclusion：The increase of the level of serum tumor markers is a common sign in the SSc patients，which may be related to the pathogenesis of the disease.But no one dares to say it is not related to the disease activity.Therefore，the increase of CA724，CA199 and CEA should not be confined in the diagnosis of gastric cancer，which needs to be further studied.

【Keywords】 systemic sclerosis；gastric cancer；chronic gastritis；tumor marker；CA724；CA199；CEA

系统性硬化症（systemic sclerosis，SSc）是以皮肤增厚和纤维化为特征并累及内脏器官，同时伴有微血管系统损害的风湿免疫性疾病[1-3]。本病世界各地都可散发，每年新发病人数为20/100万人，流行病学估计的发病率为50/100万～300/100万[4]。

Forbes等[5]报道大约10%～80%的SSc患者有恶心、呕吐、腹胀等胃部不适的症状，一部分同时伴有食欲的减退和体质量下降。研究显示，自身免疫性疾病中肿瘤标志物水平会升高。笔者在临床研究中发现，一部分SSc患者中血清肿瘤标志物CA724、CA199、CEA有升高现象。本文旨在研究SSc患者血清中CA724、CA199、CEA的含量变化及其升高的影响因素。……