淋巴细胞亚群及CA_(153)、CK_(19)、CEA在乳腺癌诊断中的应用

The applying evaluation of subgroup lymphocytes as well as CA153,CK19 and CEA in patients with breast cancer

目的：评价淋巴细胞亚群、NK细胞与CA153、癌胚抗原（CEA ）、细胞角质蛋白19（CK19）在乳腺癌中的应用价值，探讨各指标在乳腺癌诊断中的优化组合。方法测定50例乳腺癌（乳腺癌组）和50例乳腺良性疾病（良性疾病组）患者及40例健康女性（健康对照组）的外周血CD4＋、CD8＋、B （CD19＋）淋巴细胞及NK细胞的活性，血清CA153、CEA、CK19的浓度，采用ROC曲线评价各指标的诊断效能，并分别计算单项和联合指标的敏感度、特异度、阳性和阴性预测值。结果乳腺癌组CD4＋和B （CD19＋）淋巴细胞显著低于乳腺良性疾病组和健康对照组，而CD8＋和NK细胞、CA153、CEA、CK19水平则显著高于良性疾病组和健康对照组（P＜0.05），各指标在良性疾病组和健康对照组间差异无统计学意义（P＞0.05）。各指标中，NK的ROC曲线下面积（AUC ）最大为：0.875，95％ CI （0.832～0.942），其次为CA153：0.869，95％ CI （0.810～0.917）和CD4＋：0.821，95％CI （0.791～0.902），且三者敏感度相对较高；CEA的AUC最小：0.658，95％ CI （0.614～0.702），敏感度最低。乳腺癌患者各单项指标的敏感度和阴性预测值低，特异性高；与单项比较，联合检测敏感度和阴性预测值增高，特异度和阳性预测值减低，敏感度及特异度差异有统计学意义（ P＜0.01）。在所有组合中，NK＋CA153＋ CD4＋组合的敏感度和阴性预测值最高，分别为76.0％和82.0％。结论淋巴细胞亚群与肿瘤标志物联合检测可提高乳腺癌的诊断效能，优化组合NK、CA153和CD4＋测定对乳腺癌的筛查和排除具有重要应用价值。

Objective To evaluate the applying value of subgroup lymphocytes ,natural killer cell（NK） ,as well as CA153 ,CEA and cytokeratin 19（CK19 ） in patients with breast cancer ,and to explore optimal combination of the indicators in the diagonosis of breast cancer . Methods 50 patients with breast cancer ,50 patients with benign breast disease ,and 40 healthy women were gathered ,percent of CD4＋ , CD8＋ and CD19＋ lymphocytes ,NK in peripheral blood ,as well as CA153 ,CEA and CK19 levels in serum were detected ,respectively .Re-ceiver operating characteristic （ROC ） curve was used to evaluate the diagnositic efficacy of single indicator .The sensitivity ,specificity ,posi-tive predicting value and negative predicting value of single indicator and indicators’ combination were calculated ,respectively .Results Percent of CD4＋ and CD19＋ lymphocytes at group breast cancer was significantly lower ,but levels of CD8＋ and NK cell ,CA153 ,CEA and CK19 were markedly higher than that at group benign breast disease and group healthy women （ P＆lt;0.05） .There was no stastical difference for all indicators levels between group benign breast disease and group healthy women （ P＆gt;0.05 ） .NK shown a maximal area under ROC curve （AUC） of 0.875 ,95% CI （0.832~0.942） in all indicators ,the secondary and third were CA1530.869 ,95% CI（0.810~0.917） and CD4＋lymphocyte 0.821 ,95% CI（0.791~0.902） .The three indicators foregoing ,respectively ,had a higher sensitivity than that of others .CEA had a minimal AUC of 0.658 ,95% CI（0.614~0.702）with a lowest sensitivity .Each single indicator had a lower sensitivity and negative predicting value ,but a higher specificity .The sensitivity and negative predicting value increased ,but the specificity and positive predict value decreased in combined detection ,however ,the sensitivity and specificity shown significant difference compared with single detection （ P＆lt;0.01） .In all combined detections ,NK＋ CA153 ＋ CD4＋ had a highest sensitivity and negative predicting value ,which was 76.0% and 82.0% ,respectively .Conclusions Combined detection of subgroup lymphocytes and tumor markers can increase the diagnostics efficacy of breast cancer .The optimal combined detection of NK ,CA153 and CD4＋ is more valuable for screening and exclusion of breast cancer .