肿瘤标志物联合检测对肺癌诊断、病理分型和临床分期的临床价值

Clinical value of combined detection of tumor biomarkers in diagnosis,pathological typing and clinical staging in lung cancer

目的探讨血清癌胚抗原(CEA)、糖类抗原(CA)125、细胞角蛋白-19片段抗原(CYFRA21-1)、鳞状细胞癌抗原(SCC)、神经元特异性烯醇化酶(NSE)和血浆胃泌素释放肽前体(ProGRP)联合检测在肺癌诊断、病理分型、临床分期的临床价值。方法采用化学发光微粒子免疫分析技术检测378例肺癌患者、200例肺良性疾病患者和200例健康体检者血清CEA、CA125、CYFRA21-1、SCC、NSE和血浆ProGRP水平。结果肺癌患者6项肿瘤标志物水平及阳性率均显著高于肺良性疾病组和健康对照组,差异有统计学意义(P<0.05);单项检测中肺腺癌、肺鳞癌、小细胞肺癌阳性率最高的标志物分别为CEA、CYFRA21-1和SCC、NSE和ProGRP,6项肿瘤标志物联合检测灵敏度为92.86%,特异度为85.00%,准确度为88.17%,阴性预测值为92.64%,阳性预测值85.40%,除特异度和阳性预测值略有下降,其余指标均高于单项检测。CEA、CA125、CYFRA21-1、SCC、NSE和ProGRP的对肺癌受试者工作特征(ROC)曲线下面积分别为0.775、0.778、0.891、0.585、0.710和0.620,联合检测对肺癌的ROC曲线下面积为0.950。Ⅲ、Ⅳ期肺癌患者CA125、CYFRA21-1、NSE和联合检测阳性率均明显高于Ⅰ、Ⅱ期患者,差异有统计学意义(P<0.05);联合检测显著提高了各期肺癌患者诊断的阳性率。结论 CEA、CA125、CYFRA21-1、SCC、NSE和ProGRP联合检测有助于提高肺癌的诊断性能和早期检出率,有助于肺癌不同病理类型的鉴别诊断及肺癌临床分期的判断,6项肿瘤标志物联合检测是肺癌较为理想的诊断指标。

Objective To investigate the clinical value of combined detection of serum carcinoembryonic anigen（CEA） carbohydrate antigen-125 （ CA125 ） cytokeratin 19 fragment antigen （ CYFRA21-1） squamous ell carcinoma（SCC） antigen,neuron-specific enolase（NSE） and plasma progastrin-releasing peptid（ProGRP） n the diagnosis, pathological typing and clinical staging in lung cancer. Methods The serum CEA, CA125 , CYFRA21-1 SCCNSE levels and plasma ProGRP level were detected by adopting the chemiluminescent mi-roparticle immunoassay method in 378 cases of lung cancer ,200 cases of benign lung diseases and 200 people ndergoing healthy physical examination. Results The levels and positive rates of CEA,CA125 ,CYFRA21-1, CC, NSE and ProGRP in the patients with lung cancer were significantly higher than those in the patients with benign lung diseases and healthy control group-the difference was statistically significant（P〈0. 05） ; in he single index detection- the biomarkers of highest positive rate in adenocarcinoma squamous cell carcinoma nd small cell lung carcinoma were CEA,CYFRA21-1 and SCC,NSE and ProGRP respectively. The sensitivi specificity,accuracy,negative predictive value and positive predictive value of combined detection of these 6 ndexes were 92. 86%,85. 00%,88. 17%,92. 64% and 85. 40% respectively, except the specificity and positive redictive value were slightly decreased,the levels of other indexes were higher than those of single index de-ection. The aresa under the receiver operating characteristic （ROC） curves of CEA, CA125 , CYFRA21-1 SCC-NSE and ProGRP were 0. 775,0. 778,0. 891,0. 585,0. 710 and 0. 620 respectively. The area under ROC curves of the combined detection was 0. 950. The positive rates of CA125 -CYFRA21-1 -NSE and the combined detection in the patients with stage Ⅲ-Ⅳ of lung cancer were obviously higher those in the patients with stage Ⅰ and Ⅱ of lung cancer,the difference was statistically significant（P〈0. 05） ;the combined detection obviously improved the positive rates for the diagnosis in the patients with different stages of lung cancer. Conclusion The combined detection of CEA - CA125 - CYFRA21-1 - SCC- NSE and ProGRP is conducive to improve the di-agnosis performance and early detection rate for lung cancer - differentially diagnosing different pathological types of lung cancer and judge the clinical stage of lung cancer. The combined detection of 6 tumor biomarkers is an ideal diagnosis index of lung cancer.