血浆胃泌素释放肽前体,细胞角蛋白19和癌胚抗原联合检测对各型肺肿瘤的诊断价值

The value of plasma pro-gastrin-releasing peptide,cytokeratin 19-fragments and carcinoembryonic antigen in patients with lung cancer

目的探讨胃泌素释放肽前体(ProGRP),细胞角蛋白19(CYFRA21-1),及癌胚抗原(CEA)对各型肺癌的诊断价值。方法检测85例健康对照人群、49例肺良性疾病患者及143例各型肺癌患者血浆中的ProGRP,CYFRA21-1,CEA三个指标,并对其中的小细胞肺癌(SCLC)患者进行ProGRP的跟踪监测。结果 SCLC患者中ProGRP水平(中位数(M)179.1ng/ml)明显高于肺腺癌(M35.3ng/ml)、鳞癌(M33.3ng/ml)、健康对照(M35.6ng/ml)和良性肺病(M33.3ng/ml),差异有统计学意义(SCLC与腺癌和鳞癌比较,U值分别为930.0和957.0,P【0.001);ProGRP以60.7ng/ml为临界值时,对SCLC的诊断灵敏度和特异性分别为60.6%和95.0%,明显高于肺腺癌或肺鳞癌的诊断灵敏度和特异性。SCLC治疗有效组,ProGRP可降低45.9%,SCLC疾病进展组,ProGRP升高了103.1%,差异均有统计学意义(Z值均为-2.023,P【0.05)。CYFRA21-1对肺鳞癌的诊断灵敏度(65.1%)高于SCLC(33.3%),差异有统计学意义(χ2值为7.549,P【0.01)。CEA对肺腺癌的诊断灵敏度(77.0%)高于SCLC(40.9%)和肺鳞癌(32.6%),差异均有统计学意义(χ2值分别为14.195和22.151,P【0.01)。CEA在转移性肺腺癌水平(M10.22ng/ml)明显高于无转移性肺腺癌(M3.85ng/ml)和鳞癌(M2.56ng/ml),差异有统计学意义(H值为8.402,P【0.01)。结论血浆ProGRP是一个较好的SCLC诊断指标和疗效评价指标;CYFRA21-1对非小细胞肺癌的诊断具有一定的价值;CEA明显升高可作为腺癌肺外转移指标。

Objective To evaluate the value of plasma ProGRP,CYFRA 21-1 and CEA in patiens with lung cancer.Methods The levels of plasma ProGRP,CYFRA 21-1 and CEA were detected in 85 health adults,49 benign lung diseases and 143 lung neoplasms.The levels of ProGRP in the patients with SCLC was monitored.Results The level of plasma ProGRP in SCLC(M 179.1 ng/mL)was significantly higher than adenocarcinoma(M 35.3 ng/mL),squamous-cell carcinoma(M 33.3 ng/mL),health group(M 35.6ng/m)and benign lung diseases(M 33.3ng/m),the differences were statistically significant(P<0.001).When the cut-off value of ProGRP was at the 60.7 ng/mL,the sensitivity and specificity for diagnosing SCLC were 60.6% and 95.0% respectively.In the effective treatment SCLC group,ProGRP reduced 45.9%,and in the disease progression group,ProGRP increased 103.1%,the differences were statistically significant(P<0.05).The sensitivity of CYFRA 21-1 for diagnosing squamous-cell carcinoma(65.1%)was higher than SCLC(33.3%),the difference was statistical significant(P<0.01).The sensitivity of CEA for diagnosing adenocarcinoma(77.0%)was higher than SCLC(40.9%)or squamous-cell carcinoma(32.6%),the differences were statistical significant(P<0.01).The level of CEA in the metastatic adenocarcinoma(M 10.22 ng/mL)was significantly higher than non-metastatic adenocarcinoma(M 3.85 ng/mL)and squamous cell carcinoma(M 2.56 ng/mL),the differences were statistically significant(P<0.01).Conclusion The plasma ProGRP is a good indicator for diagnosing SCLC and evaluating cure effect of SCLC;CYFRA 21-1 is a valuable parameter for diagnosing NSCLC;the high expression of CEA is related to the metastatic adenocarcinoma.