五种血清肿瘤标志物单个或联合检测在肺癌诊断中作用的初步评价

A preliminary evaluation of diagnostic value of five serum tumor markers for lung cancer

目的初步评价细胞角蛋白19的片段(Cyfra21-1)等5种肿瘤标志物单个或联合检测在肺癌诊断,尤其是早期诊断中的作用。方法采用电化学发光免疫法检测了124例肺癌和41例非肿瘤肺病患者血清中Cyfra21-1、癌胚抗原(CEA)、神经元烯醇化酶(NSE)、糖链抗原19-9(CA19-9)及鳞状细胞抗原(SCCAg)等五种标志物的水平。结果CEA特异性最高,达97.56%,Cyfra21-1最低,为73.17%;CEA、Cyfra21-1及NSE的敏感性分别在腺癌、鳞癌、小细胞肺癌中最高(分别为68.29%、62.30%、66.47%);Cyfra21-1、NSE在早期和晚期肺癌中的敏感性无显著性差异(P>0.05)。联合检测Cyfra21-1+CEA诊断肺癌的特异性和敏感性分别为70.73%和66.13%;同时检测3或4个标志物可提高诊断的敏感性,但特异性却明显降低;Cyfra21-1+CEA、Cyfra21-1+CA19-9诊断早期和晚期肺癌的敏感性无显著性差异(P>0.05)。结论作为肺癌筛查指标,上述标志物均不理想;CEA>10μg/L对肺癌,尤其是腺癌的定性诊断有较大价值;Cyfra21-1和NSE分别是鳞癌和小细胞肺癌较好的标志物,两者在肺癌早期诊断中均可能有一定价值。Cyfra21-1+CEA可能是诊断肺癌(包括早期)的一个较佳组合。

Objective To evaluate the diagnostic values of five detected tumor markers individually or in different combinations for lung cancer. Methods The serum levels of 5 tumor markers, including Cyfra21-1, CEA, NSE, CA19-9 and SCCAg, were assayed in 124 patients with lung cancer and 41 patients with benign lung disease using electrochemiluminescence immunoassay. Results CEA had the highest specificity of 97.56%, and Cyfra21-1 the lowest specificity of 73. 17% ; the highest sensitivity of CEA, Cyfra21-1and NSE were 68.29% in adenocarcinoma （P〈0.05）, 62.30% in squamous cell carcinoma （ P〈0. 001 ） and 66.47% in small cell lung cancer （SCLC, P〈0. 005）, respectively. The sensitivity of each of Cyfra21-1 and NSE in localized lung cancer was lower than that in advanced lung cancer, and no significant difference was found between them. The specificity and sensitivity of combined detection of Cyfra21-1 and CEA were 70.73% and 66. 13%, respectively. The combined measurement of the above three or four biomarkers increased the sensitivity, but the specificity obviously decreased. The sensitivities of the combined detection of Cyfra21-1 and CA19-9, especially Cyfra21-1 and CEA in localized lung cancer, were lower than those in advanced lung cancer, without statistical difference （P〉0.05）. Conclusion Each of the five proteins could not be good screening marker for lung cancer. Serum CEA level with〉 10μg/L may be very valuable for diagnosis of lung cancer, especially for adenocarcinoma. Cyfra21-1 and NSE were better biomarkers for squamous cell carcinoma and SCLC, respectively. The combined detection of Cyfra21-1 and CEA could be used as a better pattern for diagnosis of lung cancer.