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위암환자의 혈청 CEA , CA19 - 9 및 AFP 에 관한 연구
최환준(Hwan Jun Choi),이신호(Shin Ho Lee),박무인(Moo In Park),우인기(In Ki Woo),김병립(Byung Lip Kim),최종수(Jong Soo Choi),지상근(Sang Geun Ghi),구자영(Ja Young Koo),정숙금(Sook Kum Jeong),허만하(Man Ha Huh) 대한내과학회 1994 대한내과학회지 Vol.47 No.5
N/A Objectives: For the diagnosis and evaluation of gastric cancer, various methods including upper GI series, endoscopy, ultrasound, CAT scan are used with serum tumor markers, especially CEA, CA19-9 and AFP. Although many studies were done to evaluate the clinical usefulness of serum tumor markers for the diagnosis and management of gastrointestinal cancer, the studies which was done in depth on gastric cancer alone were few. In this study we, therefore, evaluated clinical significance of serum CEA, CA19-9 and AFP of 712 gastric cancer patients for the diagnosis and management of gastric cancer. Methods: Serum levels of CEA, CA19-9 and AFP were measured in 712 eases of gastric cancer including 346 operative cases to evaluate the clinical usefulness of these markers for the diagnosis and management of gastric cancer. The cutoff level of serum CEA, CA19-9 and AFP were 10 ng/ml, 37 U/ml and 20 ng/ml, respectively. The serum levels were correlated with the stage, the location, the gross type, the depth of invasion, the nodal and distant metastasis. AFP-positive cases were analysed seperately and immunohistochemical staining was done to asses the presence of AFP, EGF and TGF β in the cancer tissue. Results: 1) Overall positivity of CEA, CA19-9 and AFP was 27.8% (198 cases), 32.7%; (233 cases) and 5.6% (30 cases/540 cases), respectively. 2) There was no difference in the positivity of serum CEA and CA19-9 according to locations and gross types of the cancer, but significant (p<0.05) difference in the positivity of serum CEA and CA19-9 was noted between cases of early gastric cancer (3.0% and 0.0%) and advanced gastric cancer (19.2% and 30.4%). 3) The positivity of serum CEA of stage IV (35.5%) was significantly (p<0.05) higher than that of stage II (4.4%), stage IIIA (10.2%) and stage IIIB (15.1%). Furthermore, 70.4% of the cases of positive serum CEA belonged to stage IV. On the other hand, serum CA19-9 positivity was 6.7%, 23.7%, 34.0% and 45.5% for the stage II, stage IIIA, stage IIIB and stage IU, respectively, showing significant difference between stage II and stage IIIA, IIIB, IV and between stage IIIA and stage IV (p<0.05). 4) The cases with perigastric tissue invasion (T₄) marked highest positivity (26.6%) of serum CEA level, but there was no correlation between positivity of serum CEA and depth of invasion. In the case of CA19-9, serum positivity v as 2.9%, l.5%, 29.3% and 39.8% for T₁, T₂, T₃, and T₄, respectively, showing relatively good correlation between CA19-9 positivity and depth of invasion. 5) The positivity of serum CEA and CA19-9 of NO group (3.0% and 9.9%, respectively) was significantly (p<0.05) lower than those of N2 group (15.7% and 24.5%, respectively). The positivity of N2 group (29.4% and 42.4%, respectively) was significantly higher than that of NO group and N2 gorup (p<0.05). 6) In the cases of metastasis present, CEA and CA19-9 positivity was 42.5% and 49.3%, respectively, which was significantly (p<0.05) higher than that of metastasis-negative cases (7.6g and 17.39, respectively). Between sites of metastasis, there was no difference in the positivity of CEA and CA19-9. 7) CEA and CA19-9 positivity in AFP-positive gastric cancer was 66.7%, 46.7%, respectively, and 83.3%, of cases belonged to stage IV, while distant metastasis was present in 73.3% of cases, among which liver was the most common site (43.3%). The AFP was demonstrated in the cancer tissue of 21 cases (91.3%) of 23 cases on which immunohistochemical staining was done. TGF β and EGF were present in 17 cases (81.0%) and 9 cases (42.9%) of AFP-positive 21 cases. Conclusion: Serum CEA and CA19-9 was not useful as a screening test in the diagnosis of gastric cancer, but may be useful in differentiating between early and advanced cases, in determining depth of invasion, and in detecting nodal and distant metastasis. Especially, CA19-9 was superior to CEA in stage grouping and in determining depth of invasion. AFP may be of some help in pred
간세포암 환자에 있어서 AST / ALT 비의 진단적 의의
박병채(Byung Chae Park),안수열(Su Yul Ahn),김영곤(Young Gon Kim),조기범(Gi Beum Cho),김미선(Mi Sun Kim),고용호(Yong Ho Ko),박무인(Mu In Park),우인기(In Ki Woo) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5
N/A To assess the possibility that the measurement in peripheral venous blood of AST/ALT ratios might be helpful in detection of hepatocellular carcinoma (HCC), the AST/ALT ratios were evaluated in 282 cases of chronic active hepatitis (CAH), 59 cases of CAH with early cirrhotic change (CAH with LC), 213 cases of liver cirrhosis (LC), and 220 cases of hepatocellular carcinoma (HCC). The ratio of male to female was 72.9% to 27.1% in HBsAg seropositive groups and 68.8% to 3I.2% in HBsAg seronegative groups, respectively. The mean age was 43.7 years old in HBsAg seropositivity and 49.9 years old in HBsAg seonegativity, respectively. In HBsAg seropositive groups, the AST/ALT ratio was 0.68+-0.30 in CAH group, 0.78+-0.19 in CAH with LC, 1.68+-0 83 in LC, 2.17+- l.60 in HCC. In HBsAg seronegative groups, AST/ALT ratio was 0.71+-0.58 in CAH group. 0.82+-0.31 in CAH with LC, 1.72+-0.87 in LC, 1.95+-1.38 in HCC. AST/ALT ratio was gradually increased according to the progress of the chronic liver disease in both HBsAg seropositive groups as well as negative groups. AST/ALT ratio was significantly (p<0.005) elevated in patients with HCC, being above 2.0, as compared to other groups. AST/ALT ratio in the patients with serum AST>200 units was higher than in those with AST<200 units, and the mean AST/ALT ratio in the HCC patients with AST.> 200 units was significantly higher than in other chronic liver disease. AST/ALT ratio above 3.3, without evidence of circulatory disturbance, was almost entirely restricted to the patients with HCC. In conclusion, since elevated AST/ALT ratio reflects the progress of chronic liver disease from CAH to HCC, a gradual increase in AST/ALT ratio might be a useful marker assessing for detection of HCC.
운동 부하 심전도 검사에서 하벽부 유도의 진단적 유용성에 관한 고찰
장태일(Tae Il Jang),최종수(Jong Su Choi),박무인(Moo In Park),김지호(Ji Ho Kim),김병립(Byeong Lib Kim),우인기(In Kee Woo),이수정(Soo Jeong Lee),문익흥(Ik Heung Moon),주승재(Seung Jae Joo),이재우(Jae Woo Lee),이덕희(Duk Hee Lee) 대한내과학회 1995 대한내과학회지 Vol.48 No.3
N/A Objectives: Many exercise test trials in patients with angina pectoris have demonstrated that precordial lead V5 is the best single lead as a marker for coronary artery disease. And the diagnostic value of ST segment depressions in the inferior leads is questionable. Methods: 170 patients had a standard exercise test and underwent diagnostic coronary angiography within 1 month of the exercise test. 71 patients had coronary artery disease (stenosis≥50%), whereas 99 patients did not. Sensitivity, specificity, and positive predictive value of each lead and lead groups were calculated to find the reliable leads. And the receiver operating characteristics(ROC) curves were used to compare the reliability between lead II and U5. Results: Multiple lead system had higher sensitivity than that of single lead system, but the specificity is decreased. Comparing the sensitivity and the specificity among each lead, lead V5 is the best single lead. ROC curve analysis also revealed that lead V5 (area=0.725) was markedly superior to lead II(area = 0.635) over multiple cut points(Z = 5.417; p < 0.01). However, the area under the lead II curve(0.635) was greater than 0.5(Z=3.05; p<0.01), suggesting that ST segment depression in lead II is also reliable for the identification of CAD. Conclusion: The precordial lead V5 is the best marker for identification of CAD in exercise test. An exercise - induced ST segment depression in the inferior leads is also valuable.