67例肺癌ECT全身骨显像及血清Cyfra21-1、NSE、CEA、CA125联合测定分析

Combing analysis the whole body bone imaging and the tumor marker of Cyfra21-1,NSE,CEA and CA125 in 67 patient with lung cancer

目的探讨肿瘤标志物Cyfra21-1、NSE、CEA、CA125与肺癌骨转移及转移程度之间的相关性。方法 ECT骨显像采用西门子e.cam SPECT,^(99m)TC-MDP为显像剂,67例确诊为肺癌的患者全部行ECT骨显像;采用罗氏电化学发光分析仪(Cabas6000.e 601)对30例健康者、33例肺结核患者及67例肺癌患者进行了血清肿瘤标志物Cyfra21-1、NSE、CEA、CA125联合测定。分析了肺癌骨转移与肿瘤标志物间的关系。结果肺癌血清肿瘤标志物Cyfra21-1、NSE、CEA、CA125明显高于肺结核及健康对照组;P<0.01。胸水中的Cyfra21-1、NSE测定值明显高于血清值;肺癌肿瘤标志物与肺癌病理类型之间有一定相关性,鳞癌Cyfra21-1为(71.45±22.81)ng/mL明显高于其他肺癌组P<0.01。小细胞肺癌NSE测定值为(98.67±36.54)ng/mL,明显高于其他肺癌组,P<0.01;67例肺癌未发生明显骨转移征象者33例,占49.3%;发生不同程度骨转移者34例,占50.7%;其中发生1～2处骨转移者14例,占20.9%;广泛骨转移者20例,占29.9%。腺癌骨转移发生率最高,达64%,其次是小细胞肺癌和鳞癌;肺癌骨转移程度与肿瘤标志物浓度有一定关系,广泛骨转移者Cyfra21-1和NSE测定值>局限转移>未转移者。结论肺癌骨转移及骨转移的程度与肿瘤标志物的表达程度有一定的相关性,多发骨转移常伴有明显的肿瘤标志物异常。肿瘤标志物Cyfra21-1有利于非小细胞性肺癌的检出,尤其是鳞癌的检出;NSE则有利于小细胞性肺癌的检出。联合测定Cyfra21 1、NSE、CEA、CA125大大提高了肿瘤检查的阳性率、灵敏度和准确度。全身骨显像及肺癌肿瘤标志物的联合检查对于肺癌的诊断和鉴别诊断有重要的临床价值。

Objective To explore the correlation between Cyfra21-1、 NSE、 CEA、CA125 and the bone metastasis in lung cancer.Methods Images were obtained on a gamma camera （E.CAM,Siemens,Erlangen,Germany）using 99mTC-MDP as a skeletal imaging agent.67 cases diagnosed as lung cancer were performed by ECT bone imaging,serum concentration of Cyfra21-1,NSE,CEA and CA125 were measured among 30 healthy individual,33 patients with pulmonary tuberculosis and 67 patients with lung cancer by electrogenerated chemiluminescence（ECL） （Roche,Germany）.Results The serum Cyfra21-1、NSE、CEA、CA125 from lung cancer were higher than that of controls group and pulmonary tuberculosis group（P〈0.01）.and the pleural Cyfra21-l and NSE were significantly higher than that in serum.In lung cancer,there are correlation between tumor marker and its pathological types.Cyfra21-1 concentration in squamous cell carcinoma were significantly higher than that of other lung cancers（P〈0.01）,NSE level in small cell lung cancer were significantly higher than that other lung cancers（P〈0.01）.33 patients with lung cancer had no obvious sign of bone metastases among 67 cases （accounting for 49.3%）,34 patients had bone metastases with varying degrees（accounting for 50.7 % ） ;Adenocarcinoma has highest incidence of bone metastasis（ 64 % ）,followed by small cell lung cancer and squamous cell carcinoma.Cyfra21-land NSE level is highest in cases with wide spread bone metastasis,followed by those with part bone metastasis and without bone metastasis in turn.Conclusion There are relationship between tumor marker and bone metastasis of lung cancer.Multiple bone metastases often were accompanied by obvious change of serum tumor marker.Cyfra21-lis a useful tool in diagnosis of non-small cell lung cancer,especially in squamous cell carcinoma.NSE is useful to identify the small cell lung cancer.Combined determination of Cyfra21-1,NSE,CEA and CA125 can improve sensitivity,accuracy and positive rate of diagnosis lung cancer.It seems that the whole body bone imaging combined Cyfra21-1,NSE,CEA and CA125 detection have important clinical value in diagnosis and identification of lung cancer.