血浆CYFRA21-1和CA125、CA199、CA153联合检测对肺癌的辅助诊断价值

The value of combined detection of plasma CYFRA21-1 and CA125, CA199, CA153 in the acces-sory diagnosis of lung cancer

目的：探讨血浆细胞角蛋白19片段（CYFRA21-1）和糖链抗原肿瘤标志物水平测定对肺癌诊断的临床意义。方法采用放射免疫分析法和化学发光免疫法检测了184例肺癌患者（包括81例肺鳞癌、68例肺腺癌和35例小细胞肺癌患者）的血浆CYFRA21-1和糖链抗原125、199和153（CA125、CA199和CA153）水平，并与51例肺部良性疾病患者和60名正常对照者进行了比较性分析；进行了肿癌标志物诊断肺癌的不同联合测定情况下的灵敏度、特异度和准确率的比较。结果与51例肺部良性疾病患者相比，184例肺癌患者的血浆CYFRA21-1、CA125、CA199和CA153水平显著升高（tCYFRA21-1=5.637， P〈0.001；tCA125=3.106， P〈0.01；tCA199=4.456， P〈0.001；tCA153=3.763， P〈0.01）。与60名正常对照者相比，184例肺癌患者的血浆CYFRA21-1、CA125、CA199和CA153水平显著升高（tCYFRA21-1=8.612，tCA125=4.067，tCA199=4.872， tCA153=8.673，P均〈0.001）。与60名正常对照者相比，51例肺部良性疾病患者的血浆CYFRA21-1水平显著升高（tCYFRA21-1=6.327，P〈0.001）；CA125和CA153水平升高（tCA125=2.264，tCA153=2.343，P均〈0.05）；CA199水平差异无统计学意义（tCA199=1.761，P〉0.05）。在184例肺癌中，81例肺鳞癌患者的血浆CYFRA21-1水平升高最为显著，68例肺腺癌患者的血浆CA125、CA199和CA153水平升高最为明显。单项肿瘤标志物检测CYFRA21-1的灵敏度（59.78%）和准确率（70.17%）最好，CA199的特异度（28.83%）最高。而四项联合检测肺癌的灵敏度（93.48%）和准确率（86.44%）为最高，明显高于单项和两项的检测。结论血浆CYFRA21-1、CA125、CA199和CA153水平测定是诊断肺癌的有价值肿瘤标志物，它们的联合测定可以提高诊断灵敏度和准确率。

Objective To explore the clinical significance of combined detection of plasma （cytokerantin-19-fragment, CYFRA21-1） and carbohydrate antigen tumor markers levels for lung cancer diagnosis. Methods The plasma CYFRA21-1 and carbohydrate antigen （CA125, CA199 and CA153） levels were measured with radio immunoassay and chemiluminescent immunoassay in 184 patients with lung cancer （including 81 cases of lung squanous carcinoma, 68 cases of adeno-carcinoma, 35 cases of small cell lung cancer）, and then compared with 51 patients with benign lung disease and 60 healthy con-trols. The sensitivities, specificities and accuracies of different combination of those markers for the diag-nosis of lung cancer were compared. Results The plasma CYFRA21-1 and carbohydrate antigen（CA125, CA199 and CA153） levels in 184 patients with lung cancer were significantly higher than those in 51 pa-tients with benign lung disease（tCYFRA21-1=5.637, P〈0.001;tCA125=3.106, P〈0.01;tCA199=4.456, P〈0.001;tCA153=3.763, P〈0.01） and 60 healthy controls（tCYFRA21-1=8.612, tCA125=4.067, tCA199=4.872, tCA153=8.673, all P〈0.001）. Compared with the 60 healthy controls, plasma levels of CYFRA21-1 in 51 cases with benign lung disease were significantly higher（tCYFRA21-1=6.327, P〈0.001）;CA125 and CA153 levels were increased＆amp;nbsp;（tCA125=2.264, tCA153=2.343, P〈0.05）;and there are no significant difference in CA199 levels （tCA199=1.761, P〉0.05）. In 184 lung cancer patients, the plasma CYFRA21-1 levels in 81 patients with lung squanous-carcinoma was the highest, but the plasma CA125, CA199, and CA153 levels in 68 patients with lung sde-no-careinoma were the highest . The CYFRA21-1 had the highest sensitivity （ 59 . 78%） and accuracy （70.17%） and CA199 had the highest specificity（28.83%） for detecting lung cancer. The combined de-tection of the four items has the highest sensitivity and accuracy （93.48%and 86.44%） in the diagnosis of lung cancer, obviously higher than single or two items combined detection. Conclusions The plasma CYFRA21-1, CA125, CA199 and CA153 were valuable tumor markers for the diagnosis of lung cancer. The combination of the tumor markers could improve the diagnostic sensitivity and accuracy.