{"id":1094,"date":"2016-12-09T14:07:55","date_gmt":"2016-12-09T13:07:55","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/09\/indikacie-a-pouzitie-nadorovych-markerov-v-klinickej-praxi\/"},"modified":"2017-10-04T14:39:44","modified_gmt":"2017-10-04T12:39:44","slug":"indications-and-usage-of-tumor-markers-in-clinical-practice","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/indications-and-usage-of-tumor-markers-in-clinical-practice\/","title":{"rendered":"Indications and usage of tumor markers in clinical practice"},"content":{"rendered":"<pre><span style=\"color: #ff0000;\"><strong>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper. <\/strong><\/span><\/pre>\n<pre><\/pre>\n<p>&nbsp;<\/p>\n<p><strong>M<\/strong><strong>o<\/strong><strong>\u017e<\/strong><strong>nos<\/strong><strong>t<\/strong><strong>i klinick\u00e9ho vyu\u017eitia<\/strong><\/p>\n<p><strong>Skr\u00edning malignity<\/strong><\/p>\n<p>Vzh\u013eadom na pomerne n\u00edzku senzitivitu (pravdepodobnos\u0165 pozit\u00edvneho testu u chorej osoby) a \u0161pecificitu (pravdepodobnos\u0165 negat\u00edvneho testu u zdravej osoby) nie je v\u00e4\u010d\u0161ina n\u00e1dorov\u00fdch markerov vhodn\u00e1 u asymptomatick\u00fdch pacientov. U symptomatick\u00fdch pacientov alebo u skup\u00edn pacientov s vysok\u00fdm rizikom v\u00fdvoja n\u00e1dorov\u00e9ho ochorenia mo\u017eno pou\u017ei\u0165 niektor\u00e9 onkomarkery (1):<\/p>\n<ul>\n<li>k \u00a0alciton\u00edn \u2013 pr\u00edbuzn\u00ed pacientov s medul\u00e1rnym karcin\u00f3mom \u0161t\u00edtnej \u017e\u013eazy<\/li>\n<li>A \u00a0FP \u2013 pacienti s cirh\u00f3zou pe\u010dene alebo po hepatit\u00edde C, ktor\u00ed s\u00fa ohrozen\u00ed vznikom karcin\u00f3mu pe\u010dene<\/li>\n<li>P SA \u2013 u mu\u017eov \u00a0nad 50 rokov, skr\u00edning karcin\u00f3mu \u00a0prostaty<\/li>\n<li>C \u00a0A 125 \u2013 u \u017eien vo veku od 30 rokov s dok\u00e1zanou mut\u00e1ciou g\u00e9nu <em>BRCA 1 <\/em>alebo u \u017eien vo veku nad 35 rokov s pozit\u00edvnou rodinnou anamn\u00e9zou karcin\u00f3mu ov\u00e1ria<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Diagnostika malignity<\/strong><\/p>\n<p>Na prim\u00e1rnu diagnostiku nie s\u00fa vhodn\u00e9 pre n\u00edzku senzitivitu a \u0161pecificitu. Z h\u013eadiska diagnostick\u00e9ho m\u00f4\u017eu by\u0165 onkomarkery n\u00e1pomocn\u00e9 pri ur\u010den\u00ed klinick\u00e9ho \u0161t\u00e1dia ochorenia (staging) a pri zis\u0165ovan\u00ed p\u00f4vodu malignity pri metast\u00e1zach nezn\u00e1meho p\u00f4vodu (2).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Ur\u010denie progn\u00f3zy<\/strong><\/p>\n<p>Nie je hlavnou \u00falohou n\u00e1dorov\u00fdch markerov. Ur\u010dit\u00fd v\u00fdznam m\u00e1 (1):<\/p>\n<ul>\n<li>A \u00a0FP, HCG \u2013 pri germinat\u00edvnych tumoroch<\/li>\n<li>C \u00a0EA \u2013 kolorekt\u00e1lnych karcin\u00f3moch<\/li>\n<li>\u03b2 2 mikroglobul\u00edn \u2013 pri myel\u00f3moch<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Sledovanie \u00fa\u010dinnosti terapie<\/strong><\/p>\n<p>Je hlavnou indik\u00e1ciou na stanovenie onkomarkerov. Vzh\u013eadom na r\u00f4zne biologick\u00e9 pol\u010dasy jednotliv\u00fdch markerov je d\u00f4le\u017eit\u00e9 spr\u00e1vne zvoli\u0165 intervaly odberov \u00a0krvi tak, aby sa zachytil efekt terapie a nie iba \u201elysis fe- nom\u00e9n\u201c (t. j. prudk\u00e9 zv\u00fd\u0161enie koncentr\u00e1cie \u00a0markera v d\u00f4sledku rozpadu buniek po protin\u00e1dorovej terapii (1).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Koncentr\u00e1cie n\u00e1dorov\u00fdch markerov by sa mali vy\u0161etri\u0165:<\/strong><\/p>\n<p>a) pri ur\u010den\u00ed diagn\u00f3zy, pred nasaden\u00edm prvej terapie<br \/>\nb) po skon\u010den\u00ed terapie \u2013 najsk\u00f4r o 3 \u2013 4 t\u00fd\u017edne od skon\u010denia terapie<br \/>\nc) \u00a0pri zmene terapie<br \/>\nd) pri nejasnom priebehu ochorenia<\/p>\n<p>Pravideln\u00fdm ur\u010dovan\u00edm hlad\u00edn n\u00e1dorov\u00fdch markerov po\u010das lie\u010dby mo\u017eno v\u010das odhali\u0165 prv\u00e9 prejavy ne\u00fa\u010dinnosti terapie. V\u00e4\u010d\u0161\u00ed d\u00f4raz treba da\u0165 na dynamiku zmien ne\u017e na absol\u00fatnu v\u00fd\u0161ku koncentr\u00e1ci\u00ed (2).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Sledovanie priebehu ochorenia<\/strong><br \/>\nJe \u010fal\u0161ou indik\u00e1ciou na stanovenie onkomarkerov. Anal\u00fdza m\u00e1 pr\u00ednos pri hodnoten\u00ed remisie, relapsu, pri podozren\u00ed na rezidu\u00e1lny n\u00e1dor. Vzostup koncentr\u00e1ci\u00ed onkomarkerov m\u00f4\u017ee predch\u00e1dza\u0165 klinick\u00fa diagn\u00f3zu aj o nieko\u013eko mesiacov. N\u00e1rast hlad\u00edn v troch po sebe nasleduj\u00facich odberoch u pacienta bez terapie treba pova\u017eova\u0165 za podozriv\u00fd z recid\u00edvy. U pacienta v remisii treba bra\u0165 do \u00favahy, \u017ee kompletn\u00e1 remisia nem\u00f4\u017ee by\u0165 hodnoten\u00e1 iba na z\u00e1klade zmien v hladin\u00e1ch n\u00e1dorov\u00fdch markerov. Pri jednotliv\u00fdch onkomarkeroch je ud\u00e1van\u00e1 koncentr\u00e1cia, pod ktorou le\u017e\u00ed v\u00e4\u010d\u0161ina hodn\u00f4t zdrav\u00fdch \u013eud\u00ed (diskrimina\u010dn\u00e1 hranica \u2013 cut off). Pri<br \/>\nhodnoten\u00ed koncentr\u00e1cie plat\u00ed, \u017ee hodnota men\u0161ia ako cut off nevylu\u010duje pr\u00edtomnos\u0165 n\u00e1dorov\u00e9ho ochorenia. Nen\u00e1dorov\u00e9 ochorenia s\u00fa spravidla sprev\u00e1dzan\u00e9 prechodn\u00fdm zv\u00fd\u0161en\u00edm koncentr\u00e1cie onkomarkera, zatia\u013e<br \/>\n\u010do hladiny pri mal\u00edgnom ochoren\u00ed s\u00fa trval\u00e9, pr\u00edpadne sa zvy\u0161uj\u00fa, m\u00f4\u017eu dosahova\u0165 nieko\u013ekon\u00e1sobn\u00e9 hodnoty.<br \/>\n<strong>Klinick\u00fd v\u00fdznam solubiln\u00fdch n\u00e1dorov\u00fdch markerov vy\u0161etrovan\u00fdch v LD Medirex CEA (karcinoembryon\u00e1lny antig\u00e9n) <\/strong><\/p>\n<p>Ide o glykoprote\u00edn s vysok\u00fdm obsahom sacharidov v molekule. Fyziologicky je produkovan\u00fd embryon\u00e1lnymi bunkami. V dospelosti je v malej miere produkovan\u00fd epitelov\u00fdmi bunkami \u010drevnej sliznice, \u017eal\u00fadka a bronchov. Podie\u013ea sa pravdepodobne na procese adh\u00e9zie a metast\u00e1zovan\u00ed buniek (1). Odpor\u00fa\u010da sa vyu\u017e\u00edva\u0165 ho na monitorovanie priebehu ochorenia a odpovede na lie\u010dbu pri karcin\u00f3moch tr\u00e1viaceho<br \/>\ntraktu, prsn\u00edka, mo\u010dov\u00e9ho mech\u00fara a obli\u010diek, adenokarcin\u00f3mov \u017eensk\u00fdch pohlavn\u00fdch org\u00e1nov, p\u013e\u00fac. Pri ben\u00edgnych ochoreniach, ako napr\u00edklad: cirh\u00f3za pe\u010dene, Crohnova choroba, \u010drevn\u00e9 polypy hodnoty<br \/>\nzvy\u010dajne nepresahuj\u00fa 10 ug\/l (tabu\u013eka 1). Mierne zv\u00fd\u0161en\u00e9 hodnoty sa objavuj\u00fa aj u faj\u010diarov (1).<\/p>\n<p><strong><br \/>\nCA 19-9<\/strong><\/p>\n<p>Je glykolipid, ktor\u00fd je syntetizovan\u00fd \u00a0v epitelov\u00fdch \u0161trukt\u00farach pankreasu, \u017el\u010dov\u00fdch \u00a0cest\u00e1ch, \u017eal\u00fadku. Obsahuje determinanty \u013eudskej krvnej skupiny Lewis (a). P\u00e4\u0165 a\u017e desa\u0165 percent popul\u00e1cie s konfigur\u00e1ciou krvnej skupiny Lewis a\/b negat\u00edv netvoria CA 19-9 (3). Preto to treba bra\u0165 do \u00favahy pri interpret\u00e1cii v\u00fdsledkov. Jeho stanovenie sa vyu\u017e\u00edva na monitorovanie efektu terapie pri kolorekt\u00e1lnych, cholangiocelul\u00e1rnych karcin\u00f3moch, karcin\u00f3moch \u00a0\u017eal\u00fadka a pankreasu. Ned\u00e1 sa vyu\u017ei\u0165 na diagnostiku karcin\u00f3mu pankreasu vo v\u010dasnom \u00a0\u0161t\u00e1diu ochorenia \u00a0pre n\u00edzku senzitivitu. Z ben\u00edgnych ochoren\u00ed zv\u00fd\u0161en\u00e9 hodnoty pozorujeme pri cholest\u00e1ze, pankreatit\u00edde, chronickej hepatit\u00edde (1) (tabu\u013eka 1).<\/p>\n<p><strong><br \/>\nCA 72-4<\/strong><\/p>\n<p>Je to vysokomolekulov\u00fd glykoprote\u00edn. Pri plode je typick\u00e1 jeho produkcia \u00a0bunkami \u00a0\u017eal\u00fadka, pa\u017eer\u00e1ka \u00a0a pankreasu. Odpor\u00fa\u010da sa vyu\u017e\u00edva\u0165 ho pri monitorovan\u00ed pacientov s karcin\u00f3mom \u017eal\u00fadka, \u010dreva, pankreasu, n\u00e1dormi ov\u00e1ri\u00ed (mucin\u00f3zne \u00a0typy). Z ben\u00edgnych ochoren\u00ed m\u00f4\u017ee by\u0165 zv\u00fd\u0161en\u00fd pri cirh\u00f3ze pe\u010dene, ak\u00fatnej pankreatit\u00edde, vredovej chorobe \u017eal\u00fadka a pri z\u00e1palov\u00fdch ochoreniach \u00a0gastrointestin\u00e1lneho traktu (tabu\u013eka 1).<\/p>\n<p><strong><br \/>\nCA 15-3<\/strong><\/p>\n<p>Ide o glykoprote\u00edn, je syntetizovan\u00fd \u00a0v epitelov\u00fdch bunk\u00e1ch v\u00fdvodov mlie\u010dnej \u017e\u013eazy, slinn\u00fdch \u017eliaz, bronchov. Klinick\u00fd v\u00fdznam m\u00e1 predov\u0161etk\u00fdm pri monitorovan\u00ed pacientov s mal\u00edgnym karcin\u00f3mom prsn\u00edka, pri ktorom jeho koncentr\u00e1cie koreluj\u00fa so \u0161t\u00e1diom ochorenia. Dynamika zmien po terapii obvykle koreluje s terapeutick\u00fdm efektom. Zv\u00fd\u0161enie CA 15-3 umo\u017e\u0148uje predpoveda\u0165\u00a0 relaps ochorenia s predstihom nieko\u013ek\u00fdch mesiacov pred niektor\u00fdmi zobrazovac\u00edmi met\u00f3dami. Mierne zv\u00fd\u0161enie m\u00f4\u017ee by\u0165 pr\u00edtomn\u00e9 aj pri niektor\u00fdch ben\u00edgnych ochoreniach prsn\u00edka, obli\u010dkov\u00fdch, pe\u010de\u0148ov\u00fdch a reumatick\u00fdch ochoreniach, fyziologicky aj v tehotenstve (tabu\u013eka 1).<\/p>\n<p><strong><br \/>\nCA 125<\/strong><\/p>\n<p>Je vysokomolekulov\u00fd \u00a0glykoprote\u00edn, fyziologicky je produkovan\u00fd vo fet\u00e1lnom obdob\u00ed bunkami coelomov\u00e9ho epitelu. V dospelosti m\u00f4\u017ee by\u0165 v obmedzenom mno\u017estve produkovan\u00fd epitelov\u00fdmi bunkami vajcovodov, bronchov, endometria, cervixu, bunkami mezotelov\u00e9ho p\u00f4vodu (pleura, perikard, peritoneum). Hodnoty u zdrav\u00fdch \u017eien s\u00fa &lt; 35 kIU\/l (1). Existuje viacero faktorov, ktor\u00e9 m\u00f4\u017eu ovplyvni\u0165 fyziologick\u00e9 hladiny CA 125 u zdrav\u00fdch \u017eien. Viacer\u00e9 \u0161t\u00fadie uk\u00e1zali, \u017ee zdrav\u00e9 \u017eeny pred menopauzou maj\u00fa vy\u0161\u0161ie s\u00e9rov\u00e9 hladiny ako \u017eeny po menopauze. K zmen\u00e1m koncentr\u00e1cie doch\u00e1dza aj po\u010das men\u0161trua\u010dn\u00e9ho cyklu a v tehotenstve, pri\u010dom najvy\u0161\u0161ie hodnoty sa vyskytuj\u00fa v I. trimestri gravidity (4). Ke\u010f\u017ee m\u00e1 n\u00edzku senzitivitu (v I. \u0161t\u00e1diu n\u00e1dorov\u00e9ho ochorenia len asi 50 % pacientok m\u00e1 patologicky \u00a0zv\u00fd\u0161en\u00fa hladinu), nie je vhodn\u00e9 ho vyu\u017e\u00edva\u0165 ako skr\u00edningov\u00e9 vy\u0161etrenie v be\u017enej popul\u00e1cii \u00a0\u017eien (4). V\u00fdnimku tvor\u00ed skupina \u017eien s rodinnou predispoz\u00edciou vzniku karcin\u00f3mu ov\u00e1ria. Jeho stanovenie m\u00e1 v\u00fdznam hlavne pri monitorovan\u00ed lie\u010dby karcin\u00f3mu ov\u00e1ria ser\u00f3zneho typu.<\/p>\n<p>Nemal\u00edgne pr\u00ed\u010diny zv\u00fd\u0161enia hladiny CA 125 m\u00f4\u017eu by\u0165 ben\u00edgne ochorenia ov\u00e1ri\u00ed a endometria, my\u00f3my uteru, endometri\u00f3za, chronick\u00e1 salpingit\u00edda a in\u00e9. Z in\u00fdch ako gynekologick\u00fdch ochoren\u00ed sa zistili zv\u00fd\u0161en\u00e9 hladiny u pa- cientok s cirh\u00f3zou pe\u010dene, ak\u00fatnou a chronickou pankreatit\u00eddou a p\u013e\u00facnymi ochoreniami, hlavne ak doch\u00e1dza \u00a0aj k postihnutiu \u00a0pleury (4) (tabu\u013eka 1).<\/p>\n<p><strong><br \/>\nHE-4 (Human epididymal protein-4)<\/strong><\/p>\n<p>Jeho tvorba bola dok\u00e1zan\u00e1 v epiteli nadsemenn\u00edka, kde zohr\u00e1va \u00falohu pri dozrievan\u00ed spermi\u00ed ako inhib\u00edtor prote\u00e1z. Taktie\u017e sa tvor\u00ed aj v epiteli respira\u010dn\u00e9ho \u00a0traktu, tkaniv\u00e1ch pohlavn\u00fdch \u00a0org\u00e1nov a tkanive ovari\u00e1lneho karcin\u00f3mu (epitelov\u00e9 karcin\u00f3my) (6).<\/p>\n<p>Karcin\u00f3my \u00a0ov\u00e1ri\u00ed patria medzi \u00a0ve\u013emi \u010dast\u00e9 pr\u00ed\u010diny \u00famrt\u00ed na onkologick\u00e9 ochorenia u \u017eien, preto\u017ee s\u00fa diagnostikovan\u00e9 \u010dasto neskoro. Ke\u010f\u017ee CA 125 vykazuje vy\u0161\u0161iu senzitivitu a\u017e v neskor\u0161\u00edch \u0161t\u00e1di\u00e1ch n\u00e1dorov\u00e9ho ochorenia, bola snaha n\u00e1js\u0165 tak\u00fd onkomarker, ktor\u00fd by zachytil rozvoj karcin\u00f3mu ov\u00e1ria v skor\u0161om \u00a0\u0161t\u00e1diu. Tak\u00fdto sa jav\u00ed HE-4. Aj samostatne m\u00e1 vy\u0161\u0161iu senzitivitu ako CA 125. Ak sa vy\u0161etruj\u00fa v kombin\u00e1cii, senzitivita aj \u0161pecificita sa e\u0161te zvy\u0161uje.<\/p>\n<p>N\u00e1rast hodn\u00f4t HE-4 mo\u017eno vyu\u017ei\u0165 na sledovanie priebehu ochorenia a \u00fa\u010dinnosti terapie aj pr\u00edpadn\u00e9ho relapsu ochorenia. Na lep\u0161ie pos\u00fadenie, \u010di ide o ben\u00edgny alebo mal\u00edgny proces na vaje\u010dn\u00edkoch, bol zaveden\u00fd Algoritmus na odhad zhubn\u00e9ho ochorenia vaje\u010dn\u00edkov \u2013 ROMA (Risk of Malignancy Algorithm). V\u00fdpo\u010det berie do \u00favahy koncentr\u00e1cie oboch n\u00e1dorov\u00fdch markerov (CA 125 aj HE-4) a menopauz\u00e1lny \u00a0status \u017eeny a odhadne riziko epitelov\u00e9ho karcin\u00f3mu ov\u00e1ria.<\/p>\n<p><em>U premenopauz\u00e1lnych \u00a0\u017eien<\/em> predstavuje vysok\u00e9 riziko n\u00e1lezu epiteli\u00e1lneho karcin\u00f3mu \u00a0ov\u00e1ria, ak je ROMA index &gt; 11,4 % a n\u00edzke riziko, ak je ROMA index &lt; 11,4 %.<\/p>\n<p><em>U postmenopauz\u00e1lnych \u017eien<\/em> je vysok\u00e9 riziko, ak je ROMA index &gt; 29,9 % a n\u00edzke riziko &lt; 29,9 %.<\/p>\n<p><strong><br \/>\nAFP (\u03b1-fetoprote\u00edn)<\/strong><\/p>\n<p>Je onkofet\u00e1lny glykoprote\u00edn produkovan\u00fd v embryon\u00e1lnom \u017e\u013atkovom vaku a fet\u00e1lnej pe\u010deni. V dospelom zdravom organizme je jeho produkcia obmedzen\u00e1 na minimum. V s\u00e9re matky, kde sa dost\u00e1va prechodom cez placentu, je d\u00f4le\u017eit\u00fdm ukazovate\u013eom fyziologick\u00e9ho v\u00fdvoja tehotenstva. V\u00fdznamn\u00e1 je predov\u0161etk\u00fdm \u00a0jeho transportn\u00e1 funkcia (1). Vyu\u017e\u00edva sa na monitorovanie priebehu hepatocelul\u00e1rneho karcin\u00f3mu, pri ktorom je AFP markerom prvej vo\u013eby a na sledovanie pacientov s germinat\u00edvnymi tumormi testes a ov\u00e1ri\u00ed (1). Nemal\u00edgnymi pr\u00ed\u010dinami zv\u00fd\u0161en\u00fdch hlad\u00edn AFP m\u00f4\u017ee by\u0165 ak\u00fatna a chronick\u00e1 v\u00edrusov\u00e1 hepatit\u00edda, cirh\u00f3za pe\u010dene a tehotenstvo (tabu\u013eka 1).<\/p>\n<p><strong><br \/>\nhCG (hum\u00e1nny choriov\u00fd gonadotrop\u00edn)<\/strong><\/p>\n<p>Ide o glykoprote\u00edn, ktor\u00fd je tvoren\u00fd dvoma \u00a0podjednotkami: \u03b1 podjednotka je spolo\u010dn\u00e1 \u00a0s horm\u00f3nmi adenohypof\u00fdzy \u00a0(LH, FSH, TSH) a \u03b2 podjednotka je \u0161pecifick\u00e1 pre hCG. Tvor\u00ed sa v sync\u00edtiotrofoblaste placenty (3). Fyziologicky jeho hladina st\u00fapa po\u010das tehotenstva, pri ktorom sa podie\u013ea na vytv\u00e1ran\u00ed imunotolerancie \u00a0matky vo\u010di plodu. Podobn\u00fa funkciu m\u00e1 pravdepodobne \u00a0aj v n\u00e1dorov\u00fdch bunk\u00e1ch (\u00fatlm imunitnej reakcie organizmu proti n\u00e1dorov\u00fdm \u00a0bunk\u00e1m) (5). hCG sa odpor\u00fa\u010da \u00a0vy\u0161etrova\u0165 pri germinat\u00edvnych tumoroch testes (spolu s AFP), choriokarcin\u00f3me, pri mola hydatidosa. Stanovenie m\u00e1 v\u00fdznam pri zhodnoten\u00ed \u0161t\u00e1dia ochorenia, pri kontrole \u00faspe\u0161nosti terapie a odhalen\u00ed recid\u00edvy (1).<\/p>\n<p><strong><br \/>\nPSA (prostatick\u00fd \u0161pecifick\u00fd antig\u00e9n)<\/strong><\/p>\n<p>Je glykoprote\u00edn, ktor\u00fd je fyziologicky\u00a0 produkovan\u00fd \u00a0v epitelov\u00fdch bunk\u00e1ch \u00a0\u017e\u013eazov\u00fdch \u00a0v\u00fdvodov \u00a0prostaty, je pr\u00edtomn\u00fd \u00a0aj v periuretr\u00e1lnych a perian\u00e1lych \u017e\u013eaz\u00e1ch. Funk\u010dne je to ser\u00ednov\u00e1 prote\u00e1za, za fyziologick\u00fdch okolnost\u00ed zabezpe\u010duje skvapalnenie semin\u00e1lnej tekutiny, \u010d\u00edm u\u013eah\u010duje pohyb spermi\u00ed. V s\u00e9re je jeho proteolytick\u00e1 aktivita blokovan\u00e1 hlavne v\u00e4zbou na \u03b1-1-chymotryps\u00edn, v men\u0161ej miere na \u03b12 makroglobul\u00edn. Ur\u010dit\u00fd podiel PSA sa vyskytuje v s\u00e9re vo vo\u013enej podobe \u00a0(fPSA), t. j. nenaviazan\u00fd na bielkoviny (10 \u2013 25 %).<\/p>\n<p>Zv\u00fd\u0161en\u00fa hodnotu v s\u00e9re nach\u00e1dzame pri ochoreniach prostaty. Hlavne sa vyu\u017e\u00edva na monitorovanie \u00fa\u010dinnosti terapie u pacientov s karcin\u00f3mom prostaty. PSA nem\u00e1 dostato\u010dn\u00fa senzitivitu a \u0161pecificitu pre karcin\u00f3m prostaty. Je s\u00edce org\u00e1novo-\u0161pecifick\u00fd, ale jeho zv\u00fd\u0161en\u00e9 hodnoty nach\u00e1dzame aj pri ben\u00edgnych \u00a0ochoreniach \u00a0(z\u00e1paly). Taktie\u017e trauma alebo mechanick\u00e9 podr\u00e1\u017edenie prostaty (vy\u0161etrenie per rectum, cystoskopia, kolonoskopia, transuretr\u00e1lna biopsia) m\u00f4\u017eu vies\u0165 k zv\u00fd\u0161eniu hladiny PSA s r\u00f4znou d\u013a\u017ekou trvania a mierou vzostupu \u00a0(tabu\u013eka 1). Mnoh\u00e9 \u00a0\u0161t\u00fadie potvrdili, \u017ee percento fPSA je v\u00fdznamne ni\u017e\u0161ie u pacientov s karcin\u00f3mom prostaty v porovnan\u00ed s pacientmi s ben\u00edgnym ochoren\u00edm. Pomer fPSA\/tPSA je v\u00fdznamn\u00fd na odl\u00ed\u0161enie ben\u00edgnej hyperpl\u00e1zie prostaty (BHP) od karcin\u00f3mu prostaty. V\u00fdrazne zvy\u0161uje senzitivitu a \u0161pecificitu \u00a0hlavne pri hladin\u00e1ch \u00a0tPSA 3 \u2013 10 ug\/l. Pri BHP b\u00fdva tento pomer obvykle vy\u0161\u0161\u00ed (nad 25 %), u pacientov s karcin\u00f3mom \u00a0je, naopak, v\u00fdrazne ni\u017e\u0161\u00ed (pod 10 %).<\/p>\n<p><strong><br \/>\nNSE (neur\u00f3n \u0161pecifick\u00e1 enol\u00e1za)<\/strong><\/p>\n<p>Ide o izoenz\u00fdm enol\u00e1zy, ktor\u00e1 katalyzuje premenu \u00a02-fosfoglycer\u00e1tu na fosfoenolpyruv\u00e1t. V norm\u00e1lnom stave je produkovan\u00fd nervov\u00fdm a p\u013e\u00facnym tkanivom plodu, v dospelosti je jeho v\u00fdskyt viazan\u00fd na neur\u00f3ny (1) (tabu\u013eka 1).<\/p>\n<p>Zv\u00fd\u0161en\u00fa aktivitu v s\u00e9re nach\u00e1dzame pri neuroblast\u00f3moch, SCLC (Small Cell Lung Cancer, malobunkov\u00fd karcin\u00f3m p\u013e\u00fac), pri ktor\u00fdch sa vyu\u017e\u00edva na monitorovanie priebehu ochorenia a m\u00e1 aj prognostick\u00fd v\u00fdznam. \u010ealej sa vyu\u017e\u00edva pri monitorovan\u00ed ochoren\u00ed \u00a0ako: meduloblast\u00f3my, retinoblast\u00f3my, karcinoidy, feochromocyt\u00f3my. Senzitivita pri metast\u00e1zach\u00a0 SCLC b\u00fdva a\u017e 80 %. Pr\u00ed\u010diny nemal\u00edgneho zv\u00fd\u0161enia hladiny v s\u00e9re s\u00fa p\u013e\u00facne a pe\u010de\u0148ov\u00e9 ochorenia (1). Falo\u0161n\u00e9 zv\u00fd\u0161enie koncentr\u00e1cie v s\u00e9re m\u00f4\u017ee by\u0165 sp\u00f4soben\u00e9 hemol\u00fdzou s\u00e9ra (uvo\u013enenie enol\u00e1zy z erytrocytov).<\/p>\n<p><strong><br \/>\nCYFRA 21-1 (fragment cytokerat\u00ednu 19)<\/strong><\/p>\n<p>Vzh\u013eadom na \u0161pecifick\u00fd v\u00fdskyt v epitelov\u00fdch bunk\u00e1ch skvam\u00f3zneho (epidermoidn\u00e9ho) typu m\u00e1 tento onkomarker vy\u0161\u0161iu org\u00e1nov\u00fa \u0161pecificitu ako ostatn\u00e9 cytokerat\u00ednov\u00e9 markery TPA alebo TPS (1). Stanovenie jeho hladiny m\u00e1 v\u00fdznam hlavne pri monitorovan\u00ed priebehu a \u00faspe\u0161nosti terapie pacientov s epidermoidn\u00fdm karcin\u00f3mom p\u013e\u00fac,\u00a0kr\u010dka maternice (spolu s SCCA), n\u00e1dorov oblasti hlavy a krku, karcin\u00f3mov mo\u010dov\u00e9ho mech\u00fara. Zv\u00fd\u0161enie hlad\u00edn v s\u00e9re m\u00f4\u017ee by\u0165 sp\u00f4soben\u00e9 \u00a0aj nemal\u00edgnymi ochoreniami: cirh\u00f3za pe\u010dene, chronick\u00e9 ochorenia obli\u010diek, astma, infekcie respira\u010dn\u00e9ho traktu (1).<\/p>\n<p><strong><br \/>\nTPS (tkanivov\u00fd polypeptidov\u00fd \u0161pecifick\u00fd antig\u00e9n)<\/strong><\/p>\n<p>TPA (tkanivov\u00fd polypeptidov\u00fd \u00a0antig\u00e9n) \u00a0vznik\u00e1 zo solubiln\u00fdch fragmentov \u00a0cytokerat\u00ednov \u00a08, 18, 19. TPS je \u0161pecifick\u00e1 \u00a0\u010das\u0165 TPA, determinant cytokerat\u00ednu \u00a018. Cytokerat\u00edny \u00a0s\u00fa z\u00e1kladnou stavebnou zlo\u017ekou buniek epiteli\u00e1lneho p\u00f4vodu. Maj\u00fa v\u00fdznamn\u00fa \u00falohu pri prolifer\u00e1cii buniek, a preto s\u00fa aj ne\u0161pecifick\u00fdmi \u00a0ukazovate\u013emi jej zmien (2).<\/p>\n<p>S\u00fa to m\u00e1lo \u0161pecifick\u00e9 markery, ich pou\u017eitie v poslednom obdob\u00ed kles\u00e1. Vhodn\u00e9 s\u00fa hlavne na sledovanie pacientov s karcin\u00f3mom mo\u010dov\u00e9ho mech\u00fara, karcin\u00f3mom prsn\u00edka, obli\u010diek \u00a0a r\u00f4znych nediferencovan\u00fdch a m\u00e1lo diferencovan\u00fdch foriem n\u00e1dorov. Ne\u0161pecificky \u00a0je zv\u00fd\u0161en\u00e1 jeho hladina pri niektor\u00fdch chorob\u00e1ch pe\u010dene a infek\u010dn\u00fdch ochoreniach (1).<\/p>\n<p><strong><br \/>\nSCCA (antig\u00e9n karcin\u00f3mov skvam\u00f3znych buniek)<\/strong><\/p>\n<p>Patr\u00ed medzi \u00a0onkomarkery bunkov\u00fdch \u00a0adh\u00e9zi\u00ed, je to diferencia\u010dn\u00fd antig\u00e9n epidermoidn\u00e9ho tkaniva. Vyu\u017e\u00edva sa na monitorovanie priebehu ochorenia \u00a0pacientov\u00a0 s n\u00e1dormi vonkaj\u0161\u00edch genit\u00e1li\u00ed, an\u00e1lneho kan\u00e1la, kr\u010dka maternice, pacientov s epidermoidn\u00fdmi n\u00e1dormi hlavy a krku a karcin\u00f3mov ko\u017ee.<\/p>\n<p><em>Nemal\u00edgne \u00a0pr\u00ed\u010diny zv\u00fd\u0161enia koncentr\u00e1cie \u00a0s\u00fa:<\/em> z\u00e1palov\u00e9 ochorenia \u00a0p\u013e\u00fac, pe\u010dene, gynekologick\u00e9 ochorenia, ren\u00e1lne zlyhanie.<\/p>\n<p><strong><br \/>\nTK (tymid\u00ednkin\u00e1za)<\/strong><\/p>\n<p>Patr\u00ed k enz\u00fdmom synt\u00e9zy DNA. Aktivita v bunke st\u00fapa po\u010das jej intenz\u00edvneho delenia. Pova\u017euje sa za marker prolifer\u00e1cie buniek. Vyu\u017e\u00edva sa hlavne na monitorovanie ochorenia a \u00faspe\u0161nosti terapie u pacientov s hematologick\u00fdmi malignitami (leuk\u00e9mie, lymf\u00f3my, myel\u00f3my a in\u00e9), pri ktorej jej aktivita koreluje so z\u00e1va\u017enos\u0165ou ochorenia.<\/p>\n<p><em>Nemal\u00edgne \u00a0pr\u00ed\u010diny zv\u00fd\u0161enia hladiny TK m\u00f4\u017eu by\u0165:<\/em> respira\u010dn\u00e9 v\u00edrusov\u00e9 infekcie, z\u00e1palov\u00e9 ochorenia p\u013e\u00fac, reumatick\u00e9 ochorenia, herpetick\u00e9 infekcie, infekcie Epsteinovho-Barrovej v\u00edrusom a in\u00e9.<\/p>\n<p><strong><br \/>\nCgA (chromogran\u00edn A)<\/strong><\/p>\n<p>Je kysl\u00fd glykoprote\u00edn, \u00a0tvoren\u00fd \u00a0439 aminokyselinami. Nach\u00e1dza sa v sekre\u010dn\u00fdch granul\u00e1ch endokrinn\u00fdch a neuroendokrinn\u00fdch buniek. \u00da\u010dinkuje ako prohorm\u00f3n, jeho degrad\u00e1cia proteol\u00fdzou sp\u00f4sobuje uvo\u013enenie biologicky akt\u00edvnych peptidov. Je u\u017eito\u010dn\u00fdm markerom pre v\u00e4\u010d\u0161inu neuroendokrinn\u00fdch \u00a0n\u00e1dorov (karcinoid, feochromocyt\u00f3m, medul\u00e1rne n\u00e1dory \u0161t\u00edtnej \u017e\u013eazy, niektor\u00e9 n\u00e1dory hypof\u00fdzy, tumory z buniek ostrov\u010dekov pankreasu) (1).<\/p>\n<p>Zv\u00fd\u0161en\u00e9 hladiny sa m\u00f4\u017eu vyskytova\u0165 aj pri malobunkov\u00fdch \u00a0karcin\u00f3moch p\u013e\u00fac a karcin\u00f3me prostaty, preto\u017ee m\u00f4\u017eu obsahova\u0165 bunky s \u010diasto\u010dnou neuroendokrinnou diferenci\u00e1ciou. Hladina chromogran\u00ednu A koreluje s ve\u013ekos\u0165ou tumoru, ale nie so z\u00e1va\u017enos\u0165ou sympt\u00f3mov. M\u00e1 vy\u0161\u0161iu senzitivitu v porovnan\u00ed s NSE a 5-HIAA.<\/p>\n<p><em>Falo\u0161ne zv\u00fd\u0161en\u00e9 hodnoty m\u00f4\u017eeme pozorova\u0165 aj pri:<\/em> z\u00e1paloch, ren\u00e1lnej insuficiencii, gastrit\u00edde typu A a lie\u010dbe inhib\u00edtormi prot\u00f3novej pumpy.<\/p>\n<p><strong><br \/>\nK<\/strong><strong>al<\/strong><strong>c<\/strong><strong>i<\/strong><strong>to<\/strong><strong>n\u00ed<\/strong><strong>n<\/strong><\/p>\n<p>Je polypeptidov\u00fd horm\u00f3n, produkovan\u00fd parafolikul\u00e1rnymi \u0161t\u00edtnej \u017e\u013eazy (C-bunky). Jeho stanovenie sa vyu\u017e\u00edva na sledovanie pacientov s medu- l\u00e1rnym karcin\u00f3mom \u0161t\u00edtnej \u017e\u013eazy. Hladina koreluje s ve\u013ekos\u0165ou tumoru aj s v\u00fdskytom metast\u00e1z (3). Zv\u00fd\u0161en\u00e9 hodnoty \u00a0s\u00fa aj pri zv\u00fd\u0161enej novotvorbe kost\u00ed, pri zlyhan\u00ed obli\u010diek a chronick\u00fdch z\u00e1palov\u00fdch ochoreniach.<\/p>\n<p><strong><br \/>\nTyreoglobul\u00edn (Tg)<\/strong><\/p>\n<p>Je glykoprote\u00edn obsahuj\u00faci \u00a0j\u00f3d, nach\u00e1dza \u00a0sa v koloide folikul\u00e1rnych buniek \u0161t\u00edtnej \u017e\u013eazy. Je vlastne prohorm\u00f3n, d\u00f4le\u017eit\u00fd pri intratyreoid\u00e1lnej synt\u00e9ze horm\u00f3nov T3 a T4.<\/p>\n<p>Jeho vy\u0161etrenie je n\u00e1pomocn\u00e9 \u00a0na monitorovanie priebehu ochorenia u pacientov s diferencovan\u00fdm folikul\u00e1rnym a papil\u00e1rnym karcin\u00f3mom \u0161t\u00edtnej \u017e\u013eazy. Nie je vhodn\u00fd na skr\u00edning a diagnostiku. Zv\u00fd\u0161en\u00e9 hladiny nach\u00e1dzame \u00a0aj pri Gravesovej-Basedowovej \u00a0chorobe, eufunk\u010dnej nod\u00f3znej strume alebo pri z\u00e1paloch \u0161t\u00edtnej \u017e\u013eazy (1). Pri laborat\u00f3rnom\u00a0 stanoven\u00ed koncentr\u00e1cie Tg m\u00f4\u017ee pr\u00edtomnos\u0165 protil\u00e1tok proti tyreoglobul\u00ednu (aTG) ovplyvni\u0165 v\u00fdsledok, ke\u010f\u017ee tieto protil\u00e1tky sa via\u017eu na tyreoglobul\u00edn a ten u\u017e potom nie je schopn\u00fd reagova\u0165 v analytickej reakcii. Preto pri vy\u0161etren\u00ed hladiny Tg sa v\u017edy s\u00fa\u010dasne stanovuje aj koncentr\u00e1cia aTG.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>I<\/strong><strong>n<\/strong><strong>dik<\/strong><strong>a<\/strong><strong>\u010d<\/strong><strong>n<\/strong><strong>\u00e9 obmedzenia Predanalytick\u00e9 inform\u00e1cie <\/strong><\/p>\n<p><strong>Odber:<\/strong><\/p>\n<p>V\u0161etky uveden\u00e9 \u00a0n\u00e1dorov\u00e9 markery vy\u0161etrujeme zo s\u00e9ra. Odber je potrebn\u00e9 vykona\u0165 do \u0161tandardnej g\u00e9lovej biochemickej sk\u00famavky. Onkomarkery nevy\u017eaduj\u00fa \u0161peci\u00e1lne odberov\u00e9 a transportn\u00e9 podmienky. V\u00fdnimkou je iba kalciton\u00edn, ktor\u00fd mus\u00ed by\u0165 do laborat\u00f3ria dodan\u00fd do 4 hod\u00edn od odberu.<\/p>\n<p><strong>Interferencia<\/strong><\/p>\n<p>Hemol\u00fdza \u00a0s\u00e9ra interferuje pri stanoven\u00ed: NSE, TK, TPS. V lipemick\u00fdch s\u00e9rach s koncentr\u00e1ciou triacylglycerolov &gt; 10,3 mmol\/l nie je mo\u017en\u00e9 stanovi\u0165 CA 15 \u2013 3 a koncentr\u00e1cia TAG &gt; 11,4 mmol\/l interferuje pri stanoven\u00ed CEA, tPSA, fPSA.<\/p>\n<p><strong>Met\u00f3da<br \/>\n<\/strong><em>Onkomarkery stanovujeme t\u00fdmito met\u00f3dami:<\/em><\/p>\n<p>ECLIA (elektrochemiluminiscen\u010dn\u00e1 anal\u00fdza) \u2013 AFP, hCG, CA19-9, CA125, CA72-4, CYFRA21-1, NSE, HE-4, Tg; ELISA (enzyme-linked immuno sorbent assay) \u2013 chromogran\u00edn \u00a0A, TPS, SCCA; RIA (r\u00e1dioimunoanal\u00fdza) \u00a0\u2013 TK; LIA (chemiluminiscen\u010dn\u00e1 \u00a0anal\u00fdza) \u2013 CEA, CA15-3, PSA, fPSA, kalciton\u00edn.<\/p>\n<p><strong>K\u00f3dy vy\u0161etren\u00ed<br \/>\n<\/strong><em>Vy\u0161etrenia vykazujeme pod t\u00fdmito k\u00f3dmi:<\/em><\/p>\n<p>AFP \u2013 4361, HCGm \u2013 4440, CEA \u2013 4353, CA19-9 \u00a0\u2013 4446, CA72-4 \u00a0\u2013 4470, CA125 \u2013 4444, NSE \u2013 4451, tPSA \u2013 4355, CA15-3 \u2013 4445, CYFRA 21-1 \u2013 4480, Tymid\u00ednkin\u00e1za \u2013 4358, SCCA \u2013 4481, HE-4 \u2013 44424, TPS \u2013 4472, Chromogran\u00edn A \u2013 4466, Kalciton\u00edn \u2013 4371, Tyreoglobul\u00edn \u2013 4435.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Z<\/strong><strong>\u00e1<\/strong><strong>ver<\/strong><\/p>\n<p>Mal\u00edgne n\u00e1dory maj\u00fa v s\u00fa\u010dasnosti narastaj\u00facu incidenciu v popul\u00e1cii a s\u00fa \u010dastou pr\u00ed\u010dinou \u00famrt\u00ed. Ke\u010f\u017ee terapeutick\u00e9 postupy s\u00fa \u00fa\u010dinn\u00e9 hlavne v za\u010diato\u010dn\u00fdch \u0161t\u00e1di\u00e1ch ochoren\u00ed, je snaha odhali\u0165 n\u00e1dorov\u00e9 ochorenie \u010do najsk\u00f4r. Napriek tomu, \u017ee mnoh\u00e9 onkomarkery nie s\u00fa vhodn\u00e9 na pou\u017eitie na prim\u00e1rnu diagnostiku ochorenia, s\u00fa viacer\u00e9 mo\u017enosti ich vyu\u017eitia, o ktor\u00fdch je vhodn\u00e9 vedie\u0165.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Dos<\/strong><strong>t<\/strong><strong>up<\/strong><strong>nos<\/strong><strong>\u0165 vy\u0161etrenia<\/strong><\/p>\n<p>V\u00e4\u010d\u0161ina parametrov \u00a0je vy\u0161etrovan\u00e1 \u00a0v oboch centr\u00e1lnych laborat\u00f3- ri\u00e1ch (Bratislava aj Ko\u0161ice). Onkomarkery SCCA, TPS a TK sa vy\u0161etruj\u00fa len v Centr\u00e1lnom laborat\u00f3riu v Bratislave.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>L<\/strong><strong>it<\/strong><strong>e<\/strong><strong>ra<\/strong><strong>t<\/strong><strong>\u00fa<\/strong><strong>ra<\/strong><\/p>\n<ol>\n<li>Doporu\u010den\u00ed \u010cesk\u00e9 spole\u010dnosti klinick\u00e9 biochemie (\u010cSKB \u010cLS JEP) \u010cesk\u00e9 onkologick\u00e9 spo- le\u010dnosti (\u010cOS \u010cLS JEP) \u010cesk\u00e9 spole\u010dnosti nukle\u00e1rn\u00ed medic\u00edny (\u010cSNM \u010cLS JEP) \u2013 sekce imu- noanalytick\u00fdch metod k vyu\u017eit\u00ed n\u00e1dorov\u00fdch marker\u016f v klinick\u00e9 praxi [online]. Available from:&lt;<span style=\"color: #000000;\"><a style=\"color: #000000;\" href=\"http:\/\/www.cskb.cz\/res\/file\/doporuceni\/TM\/TM_dopor.pdf\">http:\/\/www.cskb.cz\/res\/file\/doporuceni\/ TM\/ TM_dopor.pdf<\/a>&gt;<\/span>.<\/li>\n<\/ol>\n<ol start=\"2\">\n<li>Kau\u0161itz J. V\u00fdznam a postavenie n\u00e1dorov\u00fdch markerov v skr\u00edningu, diagnostike a sledova- n\u00ed pacientov v onkol\u00f3gii. <em>O<\/em><em>nkol\u00f3gia <\/em>(Bratisl.), 2006;1(3):155-158.<\/li>\n<li>Masopust J. <em>K<\/em><em>li<\/em><em>nick\u00e1 bioch\u00e9mie- po\u017eadov\u00e1n\u00ed <\/em><em>a hodnocen\u00ed biochemick\u00fdch vy\u0161etren\u00ed. <\/em>1.vyd\u00e1n\u00ed. \u010c\u00e1st II. Praha: Karolinium, 1998. 573-621 s.<\/li>\n<\/ol>\n<ol start=\"4\">\n<li>Tureck \u00fd L. CA125 a v \u00fdznam jeho v y\u0161etrovania v gynekol\u00f3gii. <em>Praktick\u00e1 gynekol\u00f3gia<\/em>. 2007:11(3):138-143.<\/li>\n<\/ol>\n<ol start=\"5\">\n<li>Racek J, et al. <em>K<\/em><em>li<\/em><em>nick\u00e1 <\/em><em>b<\/em><em>i<\/em><em>o<\/em><em>ch<\/em><em>e<\/em><em>m<\/em><em>i<\/em><em>e<\/em>. Prvn\u00ed vyd\u00e1n\u00ed. Praha: Gal\u00e9n, Karolinum, 1999: 234-240 s.<\/li>\n<li><span style=\"color: #000000;\"><strong>\u00a0<\/strong><a style=\"color: #000000;\" href=\"http:\/\/www.diag.cz\/uploads\/letak-ovarialni-marker-HE4.pdf\">http:\/\/www.diag.cz\/uploads\/letak-ovarialni-marker-HE4.pdf<\/a><\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. &nbsp; Mo\u017enosti klinick\u00e9ho vyu\u017eitia Skr\u00edning malignity Vzh\u013eadom na pomerne n\u00edzku senzitivitu (pravdepodobnos\u0165 pozit\u00edvneho testu u chorej osoby) a \u0161pecificitu (pravdepodobnos\u0165 negat\u00edvneho testu u zdravej osoby) nie je v\u00e4\u010d\u0161ina n\u00e1dorov\u00fdch markerov<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[289],"tags":[694,699,696,698,697,692,693,695],"class_list":["post-1094","post","type-post","status-publish","format-standard","hentry","category-biochemistry","tag-biological-half-life","tag-cut-off","tag-lysis-phenomenon","tag-relapse","tag-remission","tag-sensitivity","tag-specificity","tag-staging","typ_clanku-review-article"],"acf":{"abstrakt":"<p>Tumor markers are substances present in the organism as a result of malignant process. They are produced by tumor cells or standard cells of the organism as a metabolic or immunological response to the presence of the tumor. These substances can penetrate from pathologically altered tissue into the body fluids. From there, their concentration can be determined mostly by immunochemical methods. None of the currently available tumor markers has 100 % sensitivity and specificity. However, increased concentration of tumor markers can be found in many benign diseases and even in healthy individuals. This means that tumor markers do not represent undisputed evidence of the presence of malign processes in the organism. Equally, standard levels of tumor markers do not exclude the presence of malignancy. Concentrations of tumor markers also depend on the particular method applied, therefore the patients\u2019 results established by different methods cannot be compared as this would result in erroneous interpretations<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Key words:<\/strong> sensitivity, specificity, biological half-life, staging, lysis phenomenon, remission, relapse, cut off<\/p>\n","casopis":[{"ID":995,"post_author":"7","post_date":"2016-11-16 12:14:30","post_date_gmt":"2016-11-16 11:14:30","post_content":"<h4><strong>Biochemistry <\/strong><\/h4>\r\n<ul>\r\n \t<li>Biochemical inflammation markers<\/li>\r\n \t<li>Biochemical examinations in liver diseases<\/li>\r\n \t<li>Biochemical diagnosis in diseases of GIT<\/li>\r\n \t<li>Hypoglycemia<\/li>\r\n \t<li>Urolithiasis as a result of metabolic diseases<\/li>\r\n \t<li>Indication and application of tumor markers in clinical practice<\/li>\r\n \t<li>Monoclonal gammopathies \u2013 laboratory examinations in diagnosis and monitoring<\/li>\r\n \t<li>Hormones in diagnosis of reproductive function disorders<\/li>\r\n \t<li>Cerebrospinal fluid diagnosis of diseases affecting the nervous system<\/li>\r\n \t<li>Determining trace elements in blood serum<\/li>\r\n<\/ul>\r\n<h4><strong>Genetics<\/strong><\/h4>\r\n<ul>\r\n \t<li>Assessing the therapeutic response in patients with chronic myelocyte leukemia treated with tyrosine kinase inhibitors<\/li>\r\n \t<li>Hormones in diagnosis of reproductive functions\u2019 disorders<\/li>\r\n<\/ul>\r\n<h4><strong>Hematology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Anemias \u2013 laboratory diagnosis of the most frequently prevalent types of anemia<\/li>\r\n \t<li>Laboratory and hematological technical equipment<\/li>\r\n<\/ul>\r\n<h4><strong>Immunology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Paraneoplastic neurological syndromes and in vitro diagnosis of onconeural antibodies<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab","to_ping":"","pinged":"","post_modified":"2017-08-16 21:40:20","post_modified_gmt":"2017-08-16 19:40:20","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"34","upload_clanok":{"ID":1095,"id":1095,"title":"kutisova_indikacie_a_pouzitie_nadorovych_markerov","filename":"Kuti\u0161ov\u00e1_Indik\u00e1cie_a_pou\u017eitie_n\u00e1dorov\u00fdch_markerov.pdf","filesize":164122,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/Kuti\u0161ov\u00e1_Indik\u00e1cie_a_pou\u017eitie_n\u00e1dorov\u00fdch_markerov.pdf","link":"https:\/\/www.newslab.sk\/en\/indications-and-usage-of-tumor-markers-in-clinical-practice\/kutisova_indikacie_a_pouzitie_nadorovych_markerov\/","alt":"","author":"7","description":"","caption":"","name":"kutisova_indikacie_a_pouzitie_nadorovych_markerov","status":"inherit","uploaded_to":1094,"date":"2016-12-09 12:47:19","modified":"2016-12-09 12:47:19","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1094","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1094"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1094\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1094"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1094"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1094"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}