血清肿瘤志物在诊断转移性肺癌中的临床价值

Study on the relation between serum tumor markers and metastatic lung cancer

目的探讨血清神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CYfra21-1)、癌胚抗原(CEA)和乳酸脱氢酶(LDH)在诊断转移性肺癌中的临床价值。方法收集该院肺癌中心收治的331例肺癌患者(肺癌组),另选取201例肺良性病例(肺良性病组)和215例健康体检者(健康组)为研究对象。使用电化学发光和酶法检测所有研究对象NSE、CYfra21-1、CEA和LDH水平,并比较转移性与非转移性肺癌、不同转移组织、不同肺癌分期之间NSE、CYfra21-1、CEA和LDH的水平以及各单项检测和联合检测的效果。结果肺癌组患者NSE、CYfra21-1、CEA和LDH水平均明显高于肺良性病组和健康组,差异有统计学意义(P<0.05);转移性肺癌组NSE、CYfra21-1、CEA和LDH水平明显高于非转移性肺癌组,差异有统计学意义(P<0.05);脑和骨等多处转移组的NSE和CYfra21-1水平明显高于肺内、胸膜和周围淋巴结转移组,差异有统计学意义(P<0.05);肺癌临床Ⅳ期患者的CEA水平明显高于Ⅰ、Ⅱ和Ⅲ期,T3/T4期的NSE、CYfra21-1水平明显高于T1/T2期,差异均有统计学意义(P<0.05);NSE、CYfra21-1、CEA和LDH联合检测的灵敏度明显高于单项检测,差异有统计学意义(P<0.05)。结论转移性肺癌患者血清NSE、CYfra21-1、CEA和LDH水平明显升高,且与肿瘤的转移情况和严重程度相关,联合检测可以明显提高转移性肺癌诊断的灵敏度和特异度,对转移性肺癌的早期诊断、治疗和预后监测评估有重要的临床价值。

Objective To evaluate the clinical value of neuron-specilic enolase （NSE）,cytokeratm 19 mg- merits（CYfra21-l） ,serum carcinoembryonic antigen （CEA） and serum lactate dehydrogenase （LDH） to the diagnosis of patients with matastatic lung cancer,and investigate their correlation with metastatic lung cancer. Methods The levels of serum NSE,CEA,CYfra21-1 and LDH were detected in 331 cases of lung cancer pa- tients,201 cases of benign lung disease and 215 individuals of healthy physical examination, by using electro- chemical luminescence and enzymatic methods. Results All the levels of serum tumor markers in patients with lung cancer were significantly higher than those in lung benign disease and individuals of healthy physical ex- amination （P〈0. 05） ;The levels of serum tumor markers in metastatic lung cancer were significantly higher than those in lung cancer without metastasis; The levels of NSE and CYfra21-1 in the patients with brains, bones and multiple metastases were significantly higher than the patients with pulmonary,pleural and periph- eral lymphatic metastasis（P〈0.05）. The results of CEA in the clinical stage of IV were higher than those in the clinical stage of Ⅰ-Ⅲ （P〈0.05） ;The results of NSE,CYfra21-1 in the TNM stage of T3/T4 were high- er than those in the TNM stage of T1/T2 （P〈0. 05） ;The sensitivity of combined detection is significantly higher than individual test. Conclusion The four kinds of serum tumor markers were abnormally high levels in patients with metastatic lung cancer, and have positive correlation with the transfer and severity of disease condition. The combined detection of serum markers can significantly improve the detection sensitivity and specificity in the auxiliary diagnosis of lung cancer, and provide reliable clinical predictive value for metastatic lung cancer early diagnosis, treatment and prognosis monitoring.