支气管肺泡灌洗液肿瘤标志物检查诊断肺鳞状细胞癌价值分析

Diagnostic value of determination of tumor markers in bronchoalveolar lavage fluid and serum for squamous cell carcinoma of the lung

目的:探讨支气管肺泡灌洗液(BALF)及血清中鳞状细胞癌相关抗原(SCC)、可溶性细胞角蛋白19片段(CYFRA 21-1)、癌胚抗原(CEA)浓度对肺鳞状细胞癌的诊断、TNM分期及预后的临床意义。方法:选择经组织病理学和(或)细胞学确诊的40例肺鳞状细胞癌患者作为观察组,40例肺部炎性病变患者作为对照组,采用日本Pentax EPS 3500型电子支气管镜,经气管镜收集BALF,应用酶联免疫吸附法测定两组患者BALF及血清中SCC浓度,应用化学发光法测定两组患者BALF及血清中CYFRA21-1及CEA的浓度。结果:(1)观察组BALF中SCC[(49.6±15.4)vs.(2.1±0.8)μg/L,P=0.000]、CYFRA 21-1[(245.6±95.5)vs.(2.0±0.9)μg/L,P=0.000]、CEA[(15.6±5.5)vs.(3.6±1.4)μg/L,P=0.000],血清中SCC[(13.1±6.0)vs.(1.8±0.7)μg/L,P=0.000]、CYFRA 21-1[(20.4±10.3)vs.(1.9±0.9)μg/L,P=0.000]、CEA[(5.7±2.2)vs.(3.2±1.2)μg/L,P=0.000]均高于对照组,差异有统计学意义(P<0.01)。(2)观察组BALF中SCC[(49.6±15.4)vs.(13.1±6.0)μg/L,P=0.000]、CYFRA 21-1[(245.6±95.5)vs.(20.4±10.3)μg/L,P=0.000]、CEA[(15.6±5.5)vs.(5.7±2.2)μg/L,P=0.000]均高于血清,差异有统计学意义(P<0.01)。(3)观察组Ⅲ~Ⅳ期BALF中SCC[(63.8±10.4)vs.(41.9±11.9)μg/L,P=0.000]、CYFRA 21-1[(328.3±61.0)vs.(201.1±80.0)μg/L,P=0.000]、CEA[(20.5±4.0)vs.(12.9±4.2)μg/L,P=0.000]均高于Ⅰ~Ⅱ期,差异有统计学意义(P<0.01)。结论:BALF中SCC、CYFRA 21-1及CEA的检测对肺鳞状细胞癌的早期诊断有较好的临床价值,同时对临床分期、监测病情、判断预后也有一定临床价值,值得在临床上推广应用。

Objective：Study of bronchoalveolar lavage fluid （BALF） and serum squamous cell carcino- ma antigen （SCC） , cytokeratin 19 fragment （ CYFRA 21-1 ）, carcinoembryonic antigen （CEA） concentration in lung squamous cell cancer diagnosis, staging and prognostic significance of TNM. Methods：Select by his- topathologieal and （or） cytology diagnosed 40 cases of squamous cell lung cancer patients as the observation group, 40 cases of pulmonary inflammatory disease as compared to the control group, the Japan Pentax EPS 3500 electronic bronchoscope, bronchoscopy in collection of BALF, using enzyme-linked immunosorbent assay measurement in two patients with BALF and serum concentrations of SCC, using chemiluminescence method for the determination of two groups of patients with BALF and serum CYFRA 21-1 and CEA concentration. Results： （1）Whe observation group SEE [ （49. 6 ± 15.4 ） vs. （ 2. 1 ± 0. 8 ）μg/L, P = 0. 0001, CYFRA 21-1 [ （ 245.6 ± 95.5） vs. （2.0±0.9）lxg/L, P=0.000],CEA[（15.6±5.5） vs. （3.6±l.4）μg/L,P=0. O00] inBALF, SCC[（13.1±6.0） vs. （1. 8 ±0. 7） μg/L, P =0. 0001,EYFRA 21-1[ （20. 4 ±10. 3） vs. （1.9±0.9）p,g/L,P = 0. 000 ] ,CEA [ （5.7 ± 2. 2 ） vs. （ 3.2 ± 1.2 ） Ixg/L, P = 0. 000 ] in serum were higher than the control group, the difference was statistically significant （ P 〈 0. 01 ）. @The observation group SCC [ （ 49. 6 ± 15.4 ） vs. （13.1 ±6.0）μg/L, P=0.000],CYFRA21-1[（245.6±95.5） vs. （20.4±10.3）μg/L, P=0.000], CEA [ （ 15.6 ± 5.5 ） vs. （5.7 ± 2. 2 ） txg/L, P = 0. 000 ] in BALF were higher than serum, the difference was statistically significant （P 〈0. 01 ）. @The observation group III - IV in BALF SCC[ （63.8 ± 10.4） vs. （41.9 ±ll.9）μg/L, P=0.000],CYFRA 21-1[（328.3±61.0） vs. （201.1 ± 80. 0） μg/L, P=0.000],CEA [ （20. 5 ± 4. O） vs. （ 12.9 ± 4. 2） μg/L, P = O. 000 ] was higher than that of I - II period, the difference was statistically significant （ P 〈 0. 01 ）. Conclusion： BALF SCC, CYFRA 21-1 and CEA detection in early diagno- sis of squamous cell carcinoma of the lung is of clinical value, at the same time on clinical staging, monitoring of disease, prognosis also has certain clinical value, worthy of clinical application.