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복수내 Carcinoembryonic Antigen (CEA)의 진단적 가치

Other Titles
 Diagnostic value of carcinoembryonic antigen (CEA) in ascitic fluid 
Issue Date
1986
Description
의학과/석사
Abstract
[한글] 복수는 여러 가지 양성 및 악성질환에 의해서 발생되는데 복수환자에 있어서 복수가 양성질환에 의한 복수인지 악성질환에 의한 복수인지 악성질환에 의한 복수인지 감별하기 어려운 경우가 있고, 이의 감별을 위해 여려가지 방법이 이용되고 있다. Carcinoembryoni c antigen (이하 CEA로 약함)은 흉막액내의 농도를 측정함으로써 흉곽내 악성질환 존재여부를 아는데 도움이 된다는 보고들이 있었고, 또한 Loewenstein등(1978)과 Pare등(1983) 은 암환자의 복수 CEA치가 혈청 CEA치보다 현저히 높았음을 보고하였다. 저자는 복수내 CEA가 복강내 악성질활의 존재여부와 악성질환의 복막전이 여부를 아는데 도움이 되는지를 알아보기 위하여 1985년 3월부터 1985년 10월까지 연세대학교 의과대학 부속 세브란스병원 내과에 입원하였던 복수한자 75예를 대상으로 복수 및 혈청 CEA치 를 측정하고 이를 비교 분석하여 다음과 같은 결과를얻었다. 1) 양성복수군의 복수 및 혈청 CEA치의 평균치는 각각 2.46ng/ml, 3.83ng/ml이었으며, 복수의 악성 및 양성 감별을 위한 기준치는 양성복수군외 복수 및 혈청 CEA치의 평균치에 표준편차 2배를 합한 간인 8,72ng/ml, 9.95ng/ml로 정하였다. 2) 복수 CEA치가 기준치 (8.72ng/ml) 이상은 악성복수군 9예중 6예(66.7%), 악성질환군 36예중 14예(38.9%), 양성복수군 30예중 1예 (3.3%)이었다. 복수 CEA치가 57ng/ml 이상은 모두 16예이었는데 악성복수군이 6예, 악성질환이 있었다. 3) 혈청 CEA치가 기준치 (9.95ng/ml) 이상은 악성복수군 9예중 5예(55.5%), 악성질환군 36예중 12예 (33.3%), 양성복수군 30예중 2예(6.7%)이었다. 혈청 CEA치가 50ng/ml 이상은 모두 8예이었는데 악성복수군이 3예, 악성질환군이 5예로 8예 전 예에서 복강내 악성질환이 있었다. 4) 복수 CEA치는 기준치 이상이고 혈청 CEA치가 기준치 이하는 5예이며, 이중 악성복수군이 1예, 악성질환군은 3예로 4예(80%)에 복강내 악성질환이 있었다. 5) 복강내 악성질환의 진단에 있어서 복수 CEA검사의 96.7%, 양성(陽性) 예측도는 95.2%로 매우 높았고, 감수성은 44.4%, 음성(陰性) 예측도는 53.7%로 낮았다. 6) 복강내 악성질환의 진단에 있어서 혈청 CEA검사의 특이성은 93.3%, 양성 예측도는 89.5%로 높았고, 감수성은 37.8%, 음성 예측도는 50.0%로 역시 낮았으며, 복수 CEA검사보다 낮은 진단율을 보였다. 이상의 결과로 복수 CEA검사는 감수성과 음성 예측도는 낮으나 특이성과 양성 예측도가 높아 복강내 악성질환의 존재여부를 아는데 도움이 되며, 혈청 CEA검사보다 진단율이 높았다. 또한 복수 CEA치가 50ng/㎖이상인 경우는 악성질환의 복막전이 여부를 아는데 도움 이 될 것으로 사료된다. Diagnostic Value of Carcinoembryonic Antigen (CEA)in Ascitic Fluid Chul Ho Cho Department of Medical science The Graduate School, Yonsei University (Directed by Professor Heung Jai Choi M.D.) Ascites may be caused by various benign and malignant diseases but it is sometimes difficult to determine whether the ascites is caused by benign diseases or malignant diseases. Various diagnostic methods such as ascites level and ascites/serum ratio of protein and LDH, cytology and peritoneoscopy have been used in differentiating between benign and malignant ascites. Carcinoembryonic antigen(CEA) level in pleural effusion is known to be useful to make the diagnosis of the malignant diseases in thoracic cavity. In order to determine whether ascites CEA is of help to make the diagnosis of malignant diseases in abdominal cavity and their peritoneal metastasis, both ascites CEA were measured and analyzed in 75 patients with ascites who were admitted to Yonsei University Severance Hospital from March 1985 to October 1985. The results were as follows : 1. The mean value of CEA level in ascites and serum in benign ascites group was 2.46ng/ml, and 3.83n/ml respectively. The upper limit(mean+2 S.D.)of ascites and serum CEA in benign ascites group was 8.72ng/ml, and 9.95ng/ml respectively. 2. Ascites CEA level was higher than 8.72ng/㎖ in 6 of 9 patients with malignant ascites(66.7%), 14 of 36patients with malignant diseases(38.9%), and one of 30 patients with benign ascites(3.3%). In 16 patients ascites CEA lev디 was higher than 50ng/㎖(6 patients with malignant ascites, and 10 patients with malignant diseases). All of them had malignant diseases in abdominal cavity. 3. Serum CEA level was higher than 9.95ng㎖ in 5 of 9 patients with malignant ascites(55.5%), 12 of 36 patients with malignant diseases(33.3%), and 2 of 30 patients with benign ascites(6.7%), In 8 patients serum CEA level was higher than 50ng/㎖(3 patients with malignant ascites and 5 patients with malignant diseases). All of them had malignant diseases in abdominal cavity. 4. In 5 patients ascites CEA level was higher than 8.72ng/㎖ but serum CEA level was lower than 9.95ng/㎖. Four had malignant diseases in abdominal cavity(one patient with malignant ascites and 3 patients with malignant diseases). 5. The specificity of ascites CEA(8.72ng/㎖)for malignant diseases in abdominal cavity was 96.7%, the positive predictability 95.2%, the sensitivity 44.4%, and the negative predictability 53.7%. 6. The specificity of serm CEA(9.95ng/㎖)for malignant diseases in abdominal cavity was 93.3%, the positive predictability 89.5%, the sensitivity 37.8%, and the negative predictability 50.0%, which were slightly lower than those of ascites CEA. In summary, the measurement of ascites CEA level is useful in determining the existence of malignant diseases in abdominal cavity and higher than that of serum CEA in the diagnostic accuracy. Also it is useful in predicting the peritoneal metastasis in cases with ascites CEA level higher than 50ng/㎖.
[영문] Ascites may be caused by various benign and malignant diseases but it is sometimes difficult to determine whether the ascites is caused by benign diseases or malignant diseases. Various diagnostic methods such as ascites level and ascites/serum ratio of protein and LDH, cytology and peritoneoscopy have been used in differentiating between benign and malignant ascites. Carcinoembryonic antigen(CEA) level in pleural effusion is known to be useful to make the diagnosis of the malignant diseases in thoracic cavity. In order to determine whether ascites CEA is of help to make the diagnosis of malignant diseases in abdominal cavity and their peritoneal metastasis, both ascites CEA were measured and analyzed in 75 patients with ascites who were admitted to Yonsei University Severance Hospital from March 1985 to October 1985. The results were as follows : 1. The mean value of CEA level in ascites and serum in benign ascites group was 2.46ng/ml, and 3.83n/ml respectively. The upper limit(mean+2 S.D.)of ascites and serum CEA in benign ascites group was 8.72ng/ml, and 9.95ng/ml respectively. 2. Ascites CEA level was higher than 8.72ng/㎖ in 6 of 9 patients with malignant ascites(66.7%), 14 of 36patients with malignant diseases(38.9%), and one of 30 patients with benign ascites(3.3%). In 16 patients ascites CEA lev디 was higher than 50ng/㎖(6 patients with malignant ascites, and 10 patients with malignant diseases). All of them had malignant diseases in abdominal cavity. 3. Serum CEA level was higher than 9.95ng㎖ in 5 of 9 patients with malignant ascites(55.5%), 12 of 36 patients with malignant diseases(33.3%), and 2 of 30 patients with benign ascites(6.7%), In 8 patients serum CEA level was higher than 50ng/㎖(3 patients with malignant ascites and 5 patients with malignant diseases). All of them had malignant diseases in abdominal cavity. 4. In 5 patients ascites CEA level was higher than 8.72ng/㎖ but serum CEA level was lower than 9.95ng/㎖. Four had malignant diseases in abdominal cavity(one patient with malignant ascites and 3 patients with malignant diseases). 5. The specificity of ascites CEA(8.72ng/㎖)for malignant diseases in abdominal cavity was 96.7%, the positive predictability 95.2%, the sensitivity 44.4%, and the negative predictability 53.7%. 6. The specificity of serm CEA(9.95ng/㎖)for malignant diseases in abdominal cavity was 93.3%, the positive predictability 89.5%, the sensitivity 37.8%, and the negative predictability 50.0%, which were slightly lower than those of ascites CEA. In summary, the measurement of ascites CEA level is useful in determining the existence of malignant diseases in abdominal cavity and higher than that of serum CEA in the diagnostic accuracy. Also it is useful in predicting the peritoneal metastasis in cases with ascites CEA level higher than 50ng/㎖.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117074
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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