血清CEA、SCCA、CYFRA21-1、NSE与血浆D-D联合检测对肺癌诊断的临床意义

Value of the CEA,SCCA,CYFRA21-1,NSE and D-D combined detection in the diagnosis of lung cancer

目的探讨癌胚抗原(CEA)、鳞状细胞癌抗原(SCCA)、细胞角蛋白19片段21-1(CYFRA21-1)、神经元特异性烯醇化酶(NSE)及D-二聚体(D-D)联合检测对肺癌诊断的临床意义。方法分别检测170例肺癌患者、44例肺部良性肿瘤患者及90例同期体检健康者血清CEA、SCCA、CYFRA21-1、NSE及血浆D-D含量并计算上述指标诊断肺癌的灵敏度与特异度。结果肺癌组血清CEA、SCCA、CYFRA21-1、NSE及血浆D-D水平均高于肺部良性肿瘤组及健康对照组(P均<0.05);肺癌患者血清CEA、NSE及血浆D-D水平在Ⅲ/Ⅳ期均明显高于Ⅰ/Ⅱ期(P<0.05);腺癌中CEA灵敏度最高(68.4%,65/95),小细胞肺癌中NSE灵敏度最高(71.4%,20/28),鳞癌中CYFRA21-1灵敏度最高(66.0%,31/47);血清CEA、SCCA、CYFRA21-1、NSE及血浆D-D单项检测对肺癌诊断的灵敏度分别为50.6%、37.6%、51.8%、52.4%、62.4%,特异度分别为91.8%、85.1%、87.3%、82.1%、89.6%,5项联合检测的灵敏度上升至85.3%,但特异度下降至76.1%。结论血清CEA、SCCA、CYFRA21-1、NSE与血浆D-D联合检测对肺癌辅助诊断有重要的临床意义,且优于单项检测。

Objective To evaluate the clinical value of combined detection of Carcino-embryonic antigen （ CEA）, squamous cell carcinoma antigen （ SCCA）, Cytokeratin 19 fragment 21-1 （ CYFRA21-1 ）, neuronspecific enolase （NSE） and D-direct （D-D）in patients with lung cancer. Methods The levels of serum CEA, SCCA, CY- FRA21-1, NSE, and plasma D-dimer in 170 lung cancer cases, 44 cases with benign lung benign tumor and 90 healthy controls were detected respectively. The sensitivity and specificity of those markers for the diagnosis of lung cancers were calculated. Results The lung cancer group showed higher serum CEA, SCCA, CYFRA21-1, NSE and plasma D-dimer levels than those in the benign lung tumor group and the healthy control group （ P both 〈 0.05 ）. The levels of serum CEA, NSE and plasma D-dimer at stage m/IV were higher than stage Ⅰ /Ⅱ （P both 〈 0. 05 ）. The highest sensitivity markers for adenocarcinoma, SCLC and SCC were CEA （68.4% , 65/9） , NSE （71.4% , 20/28） and CYFRA21-1 （66. 0%, 31/47） respectively. The sensitivity of serum CEA, SCCA, CYFRA21-1, NSE, and plasma D-dimer in the diagnosis of lung cancer was 50. 6% , 37.6% , 51.8% , 52. 4% and 62.4% respectively, and the specificity was 91.8% , 85.1% , 87. 3%, 82. 1% and 89. 6%. The combined sensitivity was 85.3%, but the specificity decreased to 76. 1%. Conclusion The combined detection of serum CEA, SCCA, CYFRA21-1, NSE and plasma D-dimer plays an important role in the diagnosis of lung cancer and is better than single assay.