目的 探讨全身骨显像、肿瘤标志物及碱性磷酸酶对乳腺癌骨转移的诊断及疗效评估的临床价值。方法 回顾性分析本院2011年1月至2014年1月100例临床确诊为乳腺癌患者，单光子发射型计算机辅助断层（single-photon emission computed tomography,SPECT）全身骨显像、CT扫描及肿瘤标志物[糖链抗原153（CA15-3）、癌胚抗原（CEA）及碱性磷酸酶（ALP）]检测结果，分析各项检查诊断骨转移的灵敏度、特异度和准确度，其中22例骨转移患者治疗前后均行各项检查，分析治疗前后的变化。结果 100 例乳腺癌患者中62 例发生骨转移，骨显像诊断骨转移的灵敏度为88.71%，特异度为78.95%，准确度为85.00%；CT诊断骨转移的灵敏度为72.58%,特异度为92.11%，准确度为80.00%。乳腺癌骨转移组血清CA15-3、CEA、ALP水平较未发生骨转移患者组浓度升高，差异有统计学意义（P<0.05）。随着乳腺癌骨转移分级的增高，血清CA15-3、CEA及ALP含量升高,呈正相关（P值均＜0.05，r值分别为0.65、0.40、0.63）。治疗有效组骨转移患者血清CA15-3、CEA及ALP水平均下降，差异有统计学意义（均P＜0.05）。结论 全身骨显像诊断的乳腺癌骨转移灵敏度、特异度及准确度较高；血清CA15-3、CEA及ALP检测可协助诊断骨转移并评价疗效。

Objective To explore the diagnostic value and efficiency evaluation of whole body bone scintigraphy, tumor markers and alkaline phosphatase level in breast cancer patients with bone metastases. Methods 100 patients were involved in this retrospective analysis, 62 of them were diagnosed with bone metastases. The results of whole body bone scintigraphy, CT scan, tumor makers and alkaline phosphatase were analyzed. Results The sensitivity, specificity and accuracy of whole body bone scintigraphy and computed tomography were 88.71%, 78.95%, 85.00% and 72.58%, 92.11%, 80.00%, respectively. The concentrations of CA15-3, CEA and ALP in the patients with bone metastases were statistically higher than those patients without metastases (P<0.05). The level of CA15-3, CEA and ALP level were increased and positively correlated with the number of bone metastases (r=0.65，0.40，0.63). After treatment, the levels of CA15-3, CEA and ALP were decreased and kept consistent with the number of bone metastases in patients with bone metastases. Conclusion The whole body bone scintigraphy shows high sensitivity, specificity and accuracy in the diagnosis of bone metastases, and the detection of CA15-3, CEA and ALP have important value in the evaluation treatment efficacy of breast cancer patients with bone metastasis.