血清DcR3、CEA、CYFRA21-1、NSE联合检测在原发性肺癌诊断中的意义

Significance of combined detection of serum DcR3, CEA, CYFRA21-1 and NSE in diagnosis of primary lung cancer

目的探究诱捕受体3（DcR3）、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）联合检测在原发性肺癌诊断中的意义。方法选取2015年3月至2016年6月南京医科大学第一附属医院收治的104例肺癌患者作为肺癌组，66例肺部良性病变患者作为良性病变组，选取同期来我院进行体检的健康者40名作为正常对照组。采用电化学发光免疫分析仪及酶联免疫吸附试验法测定血清中DcR3、CEA、CYFRA2ll、NSE水平，对比总体与不同病理类型、不同分期肺癌中诊断效能以及联合诊断与单项诊断效能。结果肺癌组患者血清DcR3、CEA、CYFRA21-1、NSE水平明显高于正常对照组及良性病变组（P值均〈0．05）。小细胞癌患者血清水平中DcR3、NSE水平明显高于腺癌、鳞癌患者，CEA水平明显低于腺癌、鳞癌患者（P值均〈0．05）。CEA总体诊断准确度最高，为74．28％；CYFRA211在鳞癌中诊断准确度最高，为75．68％。总体联合检测诊断准确度明显高于单项检测，特异度明显低于单项检测（P值均〈0．05）。结论血清DcR3、CEA、CYFRA21-1、NSE4项指标联合检测能够明显提高早期肺癌诊断准确度，同时对于不同分型肺癌具有一定鉴别作用。

Objective To explore the significance of combined detection of serum decoy receptor 3 （DcR3）, carcinoembryonic antigen （ CEA）, cytokeratin 19 fragment （ CYFRA21-1 ） and neuron specific enolase （NSE） in diagnosis of primary lung cancer. Methods 104 patients with lung cancer treated in the First Affiliated Hospital of Nan]ing Medical University from March 2015 to June 2016 were selected as the lung cancer group, 66 patients with benign lung diseases were selected as the benign lesion group, and 40 healthy persons examined in the same period in our hospital were selected as the normal control group. The levels of DcR3, CEA, CYFRA21-1 and NSE in serum were examined by electro-chemiluminescence immunoassay and enzyme linked immunosorbent assay. Diagnostic effects of whole, different pathological types and different stages of lung cancer, combined and single diagnostic effects were contrasted. Results The levels of serum DcR3, CEA, CYFRA21 1 and NSE in lung cancer group were significantly higher than those in normal control group and benign lesion group （all P〈 0.05）. The levels of DcR3 and NSE in serum of patients with small cell carcinoma were significantly higher than those of patients with adenocarcinoma and squamous cell carcinoma （all P〈0.05）. The level of CEA in serum of patients with small cell carcinoma was significantly lower than that of patients with adenocarcinoma and squamous cell carcinoma （all P 〈0.05）. The overall diagnostic accuracy of CEA was 74.28%, and diagnostic efficiency of CYFRA21-1 was the highest （75. 68% ） in squamous cell carcinoma. The overall diagnostic accuracy of combined detection was significantly higher than that of single detection, and the specificity was lower than that of single detection （all P〈 0.05）. Conclusions Combined detection of serum DcR3, CEA, CYFRA21-1 and NSE can obviously improve the diagnostic accuracy of lung cancer, and at the same time, it has a certain effect on different types of lung cancer.