血清CEA、CYFRA21-1、NSE、SCC和ProGRP联合检测在肺癌诊断中的价值

Diagnostic Value of Combined Detection of Serum CEA,CYFRA21-1,NSE,SCC and ProGRP Levels in Patients with Lung Cancer

目的探讨癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）、神经元特异性烯醇化酶（NSE）、鳞状细胞癌抗原（SCC）和胃泌素释放肽前体（ProGRP）在肺癌诊断中的价值。方法采用电化学发光法和酶联免疫法对228例肺癌患者、100例肺良性疾病患者及100例健康对照组者CEA、CYFRA21-1、NSE、SCC和ProGRP的含量进行检测及比较。结果肺癌组血清CEA、CYFRA21-1、ProGRP的水平明显高于肺良性疾病组和健康对照组（P〈0.05）。肺癌肿瘤标志物的血清水平与其病理类型相关,血清CEA水平在腺癌时显著升高（中位数8.64,四分位数2.72-44.76,P〈0.05）,ProGRP水平在小细胞肺癌中显著升高（中位数152.00,四分位数46.00-1209.00,P〈0.05）,而血清SCC水平则在鳞癌时显著升高（中位数1.30,四分位数0.80-2.55,P〈0.05）。Ⅲ、Ⅳ期肺癌的血清CEA、CYFRA21-1、NSE和SCC水平明显高于Ⅰ、Ⅱ期肺癌（P〈0.05）。ProGRP＋CEA＋SCC联合检测对肺癌诊断的灵敏度、特异性和约登指数分别为75.9%、81.5%和0.574,灵敏度和约登指数大于各单项标志物的检测。结论 CEA对腺癌、ProGRP对小细胞肺癌以及SCC对鳞癌具有较大的辅助诊断价值,联合检测可明显提高肺癌的灵敏度,为早期诊断治疗提供有力的证据。

Objective To study the diagnostic value of combined detection of carcinoembryonic antigen（ CEA）,cytokeratin 19 fragment（ CYFRA21-1）,neuron specific enolase（ NSE）,squamous cell carcinoma antigen（ SCC）,pro-gastrin-releasing peptide（ ProGRP） in lung cancer. Methods The levels of CEA,CYFRA21-1,NSE,SCC and ProGRP were assayed and compared among the lung cancer group（ 228 cases）,benign lung diseases group（ 100 cases） and healthy controls（ 100 cases） by electrochemiluminesence immunoassay and enzyme-linked immunosorbent assay. Results The levels of serum CEA,CYFRA21-1 and ProGRP in patients with lung cancer were significantly higher than that in patients with benign lung diseases and healthy controls（ P〈 0. 05）. CEA in adenocarcinoma was significantly higher than SCLC（ median = 8. 64,X25%-X75%= 2. 72-44. 76,P〈 0. 05）. ProGRP in SCLC was significantly higher than adenocarcinoma and squamous cell carcinoma（ median = 152. 00,X25%-X75%= 46. 00-1209. 00,P〈 0. 05）. SCC in squamous cell carcinoma was significantly higher than adenocarcinoma and SCLC（ median = 1. 30,X25%-X75%= 0. 80-2. 55,P〈 0. 05）.CEA,CYFRA21-1,NSE and SCC in stage Ⅲ,Ⅳ period lung cancer were significantly higher than StageⅠ,Ⅱlung cancer（ P〈 0. 05）. The sensitivity,specificity and Youden index of combined detection of ProGRP,CEA,SCC were 75. 9%,81. 5% and 0. 574 respectively,which was higher than that of any single detection.Conclusion CEA,ProGRP and SCC have been used in detecting lung cancer. Combined application of CEA,ProGRP and SCC can significantly improve the diagnostic sensitivity of lung cancer,and provide strong evidence for its early diagnosis and treatment.