胸腔积液5种肿瘤标志物联合检测在肺癌诊断中的价值

Value of combined detection of five tumor markers of pleural effusion in diagnosis for lung cancer

目的:探讨联合检测胸腔积液和血清中癌胚抗原(CEA)、癌抗原125(CA125)、神经原特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)和鳞状细胞癌抗原(SCC)等5种肿瘤标志物水平在肺癌临床诊断中的应用价值,以期提高鉴别良恶性胸腔积液的能力。方法:用电化学发光法检测112例肺癌患者的血清及胸腔积液标本CEA、CA125、CYFRA21-1、NSE水平,用微粒子酶免发光法检测SCC水平。结果:肺癌组患者胸腔积液及血清中5种肿瘤标志物平均水平均显著高于对照组(P<0.05),肺癌组患者胸腔积液中5种肿瘤标志物的水平均显著高于血清中的浓度(P<0.05)。CA125、CEA在肺腺癌患者中的水平与其他组比较差别有统计学意义(P<0.05),在肺腺癌、肺鳞癌、小细胞肺癌患者的胸水和血清中的检测结果之间的比较差别都有统计学意义(P<0.0 5)。NSE水平在小细胞肺癌患者明显高于其他组(P<0.05),胸水与血清中检测结果之间差别存在统计学意义(P<0.05)。CYFRA21-1、SCC在肺鳞癌患者的水平高于其他组(P<0.05),CYFRA21-1只在肺鳞癌患者的胸水与血清中检测结果之间的比较差别存在统计学意义(P<0.05)。SCC在肺鳞癌、小细胞肺癌患者的胸水与血清中检测结果之间的比较差别存在统计学意义(P<0.05)。肺癌组胸腔积液中CEA、CA125、CYFRA21-1、NSE和SCC 5种肿瘤标志物联合检测的灵敏度、特异性和阳性预测值分别为99.11%、90.06%、97.37%。血清中5种肿瘤标志物联合检测的灵敏度、特异性和阳性预测值分别为94.76%、71.87%、92.17%。结论:胸水CEA、CA125、CYFRA21-1、NSE和SCC联合检测有利于良恶性胸腔积液的鉴别诊断,联合检测可以提高肺癌诊断的敏感性,胸水5种肿瘤标志物联合检测比血清具有更重要的意义。

Objective：To investigate the application value of combined detection of the level of five tumor markers（carcinoembryonic antigen（CEA）,carbohydrate antigen 125（CA125）,neuron-specific enolase（NSE）,cytokeratin fragment 19（CYFRA21-1） and squamous cell carcinoma antigen（SCC） of the pleural effusion and the serum in the diagnosis for lung cancer in order to improve the differential diagnosis for benign and malignant ones.Methods：The levels of tumor markers（CEA,CA125,NSE and CYFRA21-1） in the pleural effusion and the serum of 112 lung cancer patients were detected by electrochemistry luminescent technique and SCC by Microparticle Enzyme Immunoassay（MEIA） technology.Results：The levels of five tumor markers of lung cancer patients were significantly higher than the control group（P0.05） and the levels of five tumor markers in the pleural effusion were higher than those in the serum（P0.05）.The levels of CEA and CA125 of the adenocarcinoma were different（P0.05） from the other groups and there were statistical meaning when compared with each group（P0.05）.Compared with the other groups,the level of NSE was significantly higher in the small cell lung cancer（P0.05） and the level in the pleural effusion and the serum of each group were different（P0.05）.The level of CYFRA21-1 and SCC of SC lung cancer were higher than the other groups.CYFRA21-1 in the pleural effusion and the serum only had difference in SC lung cancer（P0.05） and SCC in SC and small cell lung cancer（P0.05）.Sensitivity,specificity and positive predictive value of the combined detection of five tumor marker in the pleural effusion of lung cancer group were 99.11%,90.06% and 97.37% and were 94.76%,71.87% and 92.17%,respectively.Conclusion：The combined detection of five tumor markers of pleural effusion was good for the differential diagnosis for benign and malignant lung cancer and improved sensitivity of diagnosis for lung cancer.Compared with detection the level of five tumor markers in the pleural effusion,to detect the ones in serum had more important value.