胃泌素释放肽前体、神经元特异性烯醇化酶、细胞角蛋白19片段抗原21-1、鳞状上皮细胞癌抗原及人附睾蛋白4在肺癌诊断中的应用价值

Application values of progastrin-releasing peptide, neuron-specific enolase, cytokeratin 19 fragment antigen 21-1, squamous cell carcinoma antigen and human epididymis protein 4 in the diagnosis of lung cancer

目的探讨胃泌素释放肽前体(Pro-GRP)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、鳞状上皮细胞癌抗原(SCCA)和人附睾蛋白4(HE4)检测在肺癌患者诊断中的临床价值。方法回顾性分析徐州医科大学第二附属医院2020年1月至2021年12月收治住院的200例肺癌患者临床资料,根据病理类型分为肺腺癌组80例、肺鳞状细胞癌组75例、小细胞肺癌组45例,选取同期入院的肺部良性疾病患者50例和健康体检者50名。所有受试者均检测Pro-GRP、NSE、CYFRA21-1、SCCA和HE4水平,比较各指标水平在不同分组受试者中的差异。绘制受试者工作特征曲线(ROC),以病理诊断结果为金标准,比较各指标单独检测和联合检测对肺癌的诊断效能。结果肺癌组血清Pro-GRP、NSE、CYFRA21-1、SCCA、HE4水平均高于肺部良性疾病组和健康对照组(均P<0.001)。肺部良性疾病组和健康对照组血清Pro-GRP、NSE、CYFRA21-1、SCCA、HE4水平比较,差异无统计学意义(均P>0.05)。小细胞肺癌组Pro-GRP、NSE、HE4水平均高于肺腺癌组和肺鳞状细胞癌组(均P<0.05)。肺腺癌组NSE和HE4水平高于肺鳞状细胞癌组(均P<0.05),CYFRA21-1和SCCA水平均低于肺鳞状细胞癌组(均P<0.05)。HE4诊断肺癌的AUC最大(0.813),HE4诊断肺腺癌的AUC最大(0.824),CYFRA21-1诊断肺鳞状细胞癌的AUC最大(0.884),NSE诊断小细胞肺癌的AUC最大(0.959)。5种指标联合检测诊断肺癌的AUC为0.951,诊断肺腺癌和小细胞肺癌的AUC分别为0.975和0.996,CYFRA21-1、SCCA、HE4联合检测诊断肺鳞状细胞癌的AUC为0.967。结论Pro-GRP、NSE、CYFRA21-1、SCCA、HE4等指标水平对肺癌及其病理类型诊断具有一定的临床价值,各指标联合检测的诊断价值优于单一指标。

Objective To investigate the clinical values of progastrin-releasing peptide(Pro-GRP),neuron-specific enolase(NSE),cytokeratin 19 fragment antigen 21-1(CYFRA21-1),squamous cell carcinoma antigen(SCCA)and human human epididymis protein 4(HE4)detections in the diagnosis of lung cancer patients.Methods The clinical data of 200 lung cancer patients who were admitted to the Second Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2021 were retrospectively analyzed.According to the pathological type,the patients were divided into lung adenocarcinoma group(80 cases),lung squamous cell carcinoma group(75 cases)and small cell lung cancer group(45 cases).Fifty patients with benign lung diseases and 50 healthy physical examiners who were admitted to the hospital during the same period were selected.All the subjects were tested for the levels of Pro-GRP,NSE,CYFRA21-1,SCCA and HE4,and the differences of each index level in the subjects of different subgroups were compared.The receiver operating characteristic(ROC)curve was drawn,and using pathological diagnosis result as the gold standard,the diagnostic efficacy of each index alone and in combination for lung cancer was compared.Results The serum levels of Pro-GRP,NSE,CYFRA21-1,SCCA and HE4 in lung cancer group were higher than those in the benign lung diseases group and the healthy control group(all P<0.001).There were no statistical differences in the levels of serum Pro-GRP,NSE,CYFRA21-1,SCCA and HE4 between the benign lung diseases group and the healthy control group(all P>0.05).The levels of Pro-GRP,NSE and HE4 in the small cell lung cancer group were higher than those in the lung adenocarcinoma group and the lung squamous cell carcinoma group(all P<0.05).NSE and HE4 levels in the lung adenocarcinoma group were higher than those in the lung squamous carcinoma group(both P<0.05),while CYFRA21-1 and SCCA levels were lower than those in the lung squamous carcinoma group(both P<0.05).The AUC of lung cancer diagnosed by HE4 was the largest(0.813),the AUC of lung adenocarcinoma diagnosed by HE4 was the largest(0.824),the AUC of lung squamous carcinoma diagnosed by CYFRA21-1 was the largest(0.884),and the AUC of small cell lung cancer diagnosed by NSE was the largest(0.959).The AUC of lung cancer diagnosed by combined detection of 5 indicators was 0.951,the AUC of lung adenocarcinoma and small cell lung cancer diagnosed by combined detection of 5 indicators was 0.975 and 0.996,and the AUC of lung squamous cell carcinoma diagnosed by combined detection of CYFRA21-1,SCCA and HE4 was 0.967.Conclusions The levels of Pro-GRP,NSE,CYFRA21-1,SCCA,HE4 and other indicators have certain clinical values in the diagnosis of lung cancer and its pathological types,and the combined detection of each index is more valuable than a single index.