肿瘤标志物联合检测在肺癌诊断中价值

Value of joint detection of tumor markers to the diagnosis of lung cancer

目的探讨联合检测血清癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原(carbohydrate antigen,CA)19-9、CA125、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、细胞角蛋白19片段(cytokeratin 19fragments,CYFRA21-1)、鳞状上皮细胞癌相关抗原(squamous cell carcinoma antigen,SCC)对肺癌的诊断价值。方法肺腺癌患者102例(腺癌组)、肺鳞癌患者60例(鳞癌组)、肺小细胞癌患者36例(小细胞癌组)和95例体检健康者(对照组),检测4组血清CEA、CA19-9、CA125、NSE、CYFRA21-1、SCC水平,统计4组6项指标的阳性率,计算6项指标单独及联合检测诊断肺癌的灵敏性和特异性。结果腺癌组血清CEA、CA19-9、CA125、NSE、CYFRA21-1和SCC阳性率分别为67.6%、28.4%、52.0%、58.8%、51.0%、14.7%,鳞癌组分别为33.3%、11.7%、41.7%、43.3%、65.0%、40.0%,小细胞癌组分别为44.4%、16.7%、13.9%、75.0%、36.1%、2.8%,对照组分别为1.1%、0、0、5.3%、2.1%、2.1%,除SCC阳性率在小细胞肺癌组与对照组比较差异无统计意义(P>0.05)外,腺癌组、鳞癌组、小细胞癌组6项指标阳性率均高于对照组(P<0.05),腺癌组CEA、CA125阳性率高于鳞癌组和小细胞癌组(P<0.05),小细胞癌组NSE阳性率高于腺癌组和鳞癌组(P<0.05),鳞癌组SCC阳性率高于腺癌和小细胞癌组(P<0.05);血清CEA、CA19-9、CA125、NSE、CYFRA21-1和SCC单项指标诊断肺癌的敏感性分别为52.5%、21.0%、41.5%、56.5%、52.0%、20.0%,均低于6项指标联合检测(91.5%)(P<0.05)。结论血清CEA、CA19-9、CA125、NSE、CYFRA21-1、SCC6在肺癌诊断及分型诊断中均有一定价值,联合检测6项肿瘤标志物可提高肺癌诊断的敏感性。

Objective To study the value of the joint detection of serum carcinoembryonic antigen（CEA）,carbohydrate antigen（CA）19-9,CA125,neuron-specific enolase（NSE）,cytokeratin 19fragments（CYFRA21-1）and squamous cell carcinoma related antigen（SCC）to the diagnosis of lung cancer.Methods The levels of serum CEA,CA19-9,CA125,NSE,CYFRA21-1and SCC were detected in 102 patients with lung adenocarcinoma（adenocarcinoma group）,60 patients with lung squamous cell carcinoma（squamous cell carcinoma group）,36 patients with lung small cell carcinoma（small cell carcinoma group）and 95 health volunteers（control group）.The positive rates,and the sensitivity and specificity of single or joint detection of these six tumor markers were analyzed among four groups.Results The positive rates of CEA,CA19-9,CA125,NSE,CYFRA21-1and SCC were 67.6%,28.4%,52.0%,58.8%,51.0% and 14.7% in adenocarcinoma group,33.3%,11.7%,41.7%,43.3%,65.0% and 40.0% in squamous cell carcinoma group,and44.4%,16.7%,13.9%,75.0%,36.1% and 2.8% in small cell carcinoma group,significantly higher than those in control group（1.1%,0,0,5.3%,2.1%,2.1%）（P〈0.05）except SCC between small cell carcinoma group and control group（P〈0.05）.The positive rates of CEA and CA125 in adenocarcinoma group,NSE in small cell carcinoma group and SCC in squamous cell carcinoma group were the highest（P〉0.05）.The sensitivities of single detection of CEA,CA19-9,CA125,NSE,CYFRA21-1and SCC for lung cancer were 52.5%,21.0%,41.5%,56.5%,52.0%and20.0%,lower than the sensitivity of joint detection（91.5%）（P〈0.05）.Conclusion The single detection of CEA,CA19-9,CA125,NSE,CYFRA21-1or SCC has some value to the diagnosis and classification diagnosis,and the joint detection of them can improve the sensitivity for lung cancer.