肿瘤标志物联合检测在肺癌诊断中的应用价值

Clinical value of combined detection of serum tumor markers in patients with lung cancer

目的探讨血清肿瘤标志物癌胚抗原(CEA)、胃泌素释放肽前体(pro-GRP)、神经特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(SCC-Ag)、细胞角蛋白19片段(CYFRA21-1)对肺癌辅助诊断的临床价值,并选择较理想的肿瘤标志物组合。方法应用ELISA法检测50例健康者、90例肺部良性疾病患者和122例肺癌患者血清中5种肿瘤标志物水平。结果肺癌患者血清中5种肿瘤标志物水平明显高于健康组和良性肺部疾病组(P<0.01);CEA在腺癌中的检测水平明显高于其他类型肺癌(P<0.01);NSE、pro-GRP在小细胞肺癌(SCLC)中的检测水平明显高于其他类型肺癌(P<0.01);SCC-Ag在鳞癌中的检测水平明显高于其他类型肺癌(P<0.05);CYFRA21-1在鳞癌中的检测水平明显高于其他类型肺癌(P<0.01);5种肿瘤标志物组合后,敏感性明显高于单项肿瘤标志物的敏感性(P<0.01)。结论 5种肿瘤标志物在肺癌的辅助诊断和鉴别诊断中有着重要的临床意义。NSE、pro-GRP可作为联合检测小细胞肺癌的标志物组合,CEA、SCC-Ag和CYFRA21-1可作为联合检测非小细胞肺癌的标志物组合。

Objective To evaluate the clinical significance of tumor markers,including carcinoembryonic antigen（CEA）, precur- sor of gastrin-releasing peptide（pro-GRP）, neurone specific enolase（NSE）, squamous cell carcinoma antigen（SCC-Ag） and cytoker- atin-19-fragments（CYFRA21-1） ,in single or combined detection,for the diagnosis of lung cancer. Methods Serum levels of the five serum tumor markers were detected by ELISA in 50 healthy adults（healthy group）, 90 patients with benign lung disease （benign group） and 122 patients with lung cancer（cancer group）. Results Serum levels of the five serum tumor markers in cancer group were significantly higher than those in healthy group and benign group（P〈0.01）. According to different subtypes of lung cancer, serum level of CEA was the most significantly high in patients with adenoeareinoma（P〈0.01） ,of pro-GRP and NSE were the most significantly high in patients with small cell lung cancer （SCLC）, （P〈0.01） ,of SCC-Ag was the most significantly high in patients with squamous-cell carcinoma（P〈0.05） and of CYFRA21-1 was the most significantly high in patients with squamous-cell eareino- ma（P〈0.01）. The sensitivity of combined detection of these five tumor markers for the diagnosis of lung cancer was significantly higher than single detection of each marker（P〈0.01）. Conclusion The five tumor markers could be valuable for the diagnosis and differential diagnosis of lung cancer. Combination of NSE and pro-GRP could be appropriate in diagnosing SCLC,of CEA,SCC-Ag and CYFRA21-1 could be appropriate in diagnosing none-SCLC.