肿瘤标志物在肺癌诊断、病理分型和临床分期中的价值

Value of detection of serum tumor biomarkers in lung cancer diagnosis, pathological type and clinical stage

目的研究血清肿瘤相关抗原125(CA125)、199(CA199)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)在肺癌诊断、病理分型和临床分期中的价值。方法选取郑州大学第一附属医院2011年6月至2012年9月入院患者309例血清标本,采用电化学免疫荧光发光法检测血清肿瘤标志物的浓度。结果肺癌患者5种血清肿瘤标志物水平均高于肺部良性病变组。单项检测,腺癌、鳞癌、小细胞肺癌(SCCL)敏感度最高者分别为CYFRA21-1和CEA、CYFRA21-1、NSE。联合检测CA125+CEA+NSE+CYFRA21-1敏感度达87.26%。CA125、CEA、CYFRA21-1在肺癌不同TNM分期的表达阳性率及表达高度不同。结论血清5种肿瘤标志物诊断肺癌价值较高,其中CYFRA21-1诊断价值最大,联合检测可以提高肺癌诊断敏感度。CA125、CEA、CYFRA21-1在肺癌临床分期中价值较大。

Objective To evaluate the efficiency of 5 tumor biomarkers, namely carbohydrate antigen- 125 （ CA-125 ）, carbohydrate antigen-199 （ CA-199 ）, carcinoembryonic antigen （ CEA ）, neuron-specific enolase （NSE）, Cytokeratin 19 （CYFRA21-1）, independently or in combination for lung cancer diagnosis, pathological type and clinical stage. Methods Electrochemiluminesce-nce immunization was used to determine biomarker levels expressed in 309 patients with pulmonary disease. Results The observed levels of CA125, CA199, CEA, NSE and CYFRA 21-1 in patients with pathologically confirmed lung cancer were significantly higher than those in patients with benign pulmonary diseases. Adenocarcinoma, squamous cell carcinoma, and small cell lung carcinoma of the lung were associated with the highest sensitivity levels of CYFRA21-1 and CEA, CYFRA21-1, and NSE, respectively. The combination of 4 tumor biomarkers, namely, CAI25 ＋ CEA ＋ NSE ＋ CYFRA21-1 showed 87.26% sensitivity for lung cancer. The ROC of CYFRA21-1 was 0. 840 ± 0. 032 （95% CI,0. 777-0. 904）. The positive rates and levels of CA125, CEA, CYFRA21-1 were different in clinical stages of lung cancer. Conclusion CA125, CA199, CEA, NSE and CYFRA 21-1 are valuable in the diagnosis, pathological type and clinical stage of lung cancer, especially CYFRA 21-1. The combination of CA125 ＋ CEA ＋ NSE ＋ CYFRA21-1 showed higher sensitivity for lung cancer. CA125, CEA, CYFRA21-1 play an important role in clinical stage.