支气管肺泡灌洗液和血清肿瘤标志物联合检测在肺癌诊断中的价值

Combined determination of tumor markers in serum and bronchoalveolar lavage fluid for lung cancer diagnosis

目的探讨支气管肺泡灌洗液和血清中肿瘤标志物,癌胚抗原(carcinoem bryonic antigen,CEA)、细胞角质蛋白19片段(cytokeratin 19 fragment,CYFRA21-1)、神经元烯醇化酶(neuron-specific enolase,NSE)在肺癌早期诊断中的临床价值。方法采用电化学发光法测定70例肺癌住院患者及40例肺部良性疾病患者支气管肺泡灌洗液和血清中CEA、NSE、CYFRA21-1水平。结果肺癌患者支气管肺泡灌洗液和血清3项肿瘤标志物平均含量均高于肺部良性疾病患者(P<0.01)。支气管肺泡灌洗液中3种标志物的含量明显高于血清中的含量(P<0.05)。联合检测两项及3项阳性者均使支气管肺泡灌洗液和血清诊断肺癌的敏感性和准确性得到提高。Ⅲ、Ⅳ期肺癌组支气管肺泡灌洗液和血清中3项肿瘤标志物的表达水平均高于Ⅰ+Ⅱ期患者(TNM分期),Ⅰ+Ⅱ期肺癌组支气管肺泡灌洗液中3项肿瘤标志物的表达水平高于肺良性病组(P<0.05)。结论支气管肺泡灌洗液CEA、CYFRA21-1、NSE检测对肺癌的早期诊断价值优于血清,联合检测支气管肺泡灌洗液和血清中的肿瘤标志物能大大提高临床诊断肺癌的阳性率。

Objective To investigate the clinical value of bronchoalveolar lavage fluid （BALF） and serum tumor markers including carcinoembryonic antigen（ CEA）, cytokeratin 19 fragment （CYFRA21-1） and neuronspecific enolase （NSE） for the diagnosis of lung cancer. Methods The levels of above mentioned tumor markers in the BALF and serum samples of 70 patients with pathologically diagnosed lung cancer and 40 patients with benign lung diseases （BLD） were measured by electrochemiluminescence. Results The levels of 3 tumor markers in the BALF and serum were significantly higher in cancer patients than those with BLD （P 〈0.01 ）, and the levels in BALF were significantly higher than those in the serum （ P 〈 0.05 ）. The sensitivity and accuracy of diagnosing lung cancer were increased when 2 or 3 markers in BALF and serum were detected in combination. The levels of 3 tumor markers in the BALF and the serum were higher in stage Ⅲ or Ⅳ of cancer patients than in stage Ⅰ and stage Ⅱ （TNM stage）. Conclusion In diagnosis of lung cancer CEA, CYFRA21- 1, and NSE levels in the BALF have more important clinical significance than those in the serum. Combined determination of these tumor markers can increase the sensitivity and the accuracy, and might be useful to the diagnosis of lung cancer.