血清肿瘤标志物联合检测在肺癌诊断中的价值

Value of combined detection of serum tumor markers in the diagnosis of lung cancer

目的肺癌血清学肿瘤标记物检测已成为肺癌诊断的重要指标,但单个肿瘤标志物的阳性诊断率不高。本研究探讨肿瘤标志物鳞状上皮细胞癌抗原(SCC)、神经特异性烯醇化酶(NSE)、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)在肺癌患者血清中的表达水平,探讨其在肺癌诊断及鉴别诊断中的价值。方法采集127例肺癌患者、42例肺良性疾病患者和100例健康体检者血清,分别用酶联免疫法测定血清SCC表达,用电化学发光法检测血清NSE、CEA和CYFRA21-1表达。分析比较血清肿瘤标志物单项检测、联合检测的灵敏度、特异性和准确度。结果肺癌组SCC、NSE、CEA和CYFRA21-1血清表达水平均明显高于正常对照组(P均<0.05),除肺癌组CEA血清表达水平高于肺良性病变组但无显著性差异外,其余3项标志物肺癌组均明显高于肺良性病变组(P均<0.05)。SCC和CYFRA21-1在肺鳞癌患者水平最高,NSE在肺小细胞癌患者水平最高,而CEA则在肺腺癌患者水平最高。4项血清标记物联合检测的灵敏度和准确度分别为82.68%和91.08%,显著高于各单项的灵敏度和准确度。结论血清SCC、NSE、CEA和CYFRA21-1检测对肺癌有一定的诊断价值,联合检测可提高灵敏度和准确度。

Objective To test the levels of serum squamous cell carcinoma antigen（ SCCA）,neurone specific enolase（ NSE）,carcinomacmbryonic antigen（ CEA） and cytokeratin-19 fragment（ CYFRA21-1） in patients with lung cancer,and explore their role in the diagnosis and differential diagnosis of lung cancer. Methods The serum samples of 127 patients with pulmonary carcinoma,42 patients with pulmonary benign lesion and 100 healthy volunteers were prepared and tested by using ELISA for the levels of SCC,electro-chemiluminescence immunoassay for levels of NSE,CEA and CYFRA21-1.The sensitivity,specificity and accuracy of the single test and combined test in tumor markers were compared. Results The serum of SCC,NSE,CEA and CYFRA21-1 in patients with lung cancer were significantly higher than health volunteers and patients with benign lung disease（ P 〈 0. 05）. There were significant differences of the serum levels of SCC,NSE and CYFRA21-1 between lung cancer patients and benign lung disease patients（ P 〈 0. 05）. The level of SCC and CYFRA21-1 in patients with squamous cell carcinoma was significantly higher than patients with other subtypes. The level of NSE and CEA were highest in patients with small cell lung cancer and patients with glandular carcinoma,respectively. The sensitivity of combination test was 82. 68%,and accuracy was 91. 08%,significantly higher than that of each single sensitivity and accuracy. Conclusion SCC,NSE,CEA and CYFRA21-1 are helpful in the diagnosis of lung cancer. The combined detection can improve the sensitivity and accuracy.