胸水和血清CEA、CA125、CYFRA21-1、NSE和Pro-GRP联合检测对肺癌的诊断价值

Diagnostic value of combined detection of CEA,CA125,CY FRA21-1,NSE and Pro-GRPin lung cancer pleural effusion and serum

目的:探讨联合检测肺癌胸水和血清中癌胚抗原(CEA)、癌抗原125(CA125)、细胞角蛋白19片段(CYFRA21-1)、神经原特异性烯醇化酶(NSE)和胃泌素释放肽前体(Pro-GRP)5种肿瘤标志物水平在肺癌临床诊断中的应用价值,以期提高鉴别良恶性胸水的能力。方法:用电化学发光法检测93例肺癌患者和54例肺炎性疾病患者的血清及胸水标本CEA、CA125、CYFRA21-1、NSE和Pro-GRP水平。结果:癌性胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物平均水平与炎性胸水组比较,差别均有统计学意义(P<0.05);癌性胸水组中CEA、CYFRA21-1、CA125的含量远远高于炎性胸水组(20～600倍)(P<0.01)。肺癌胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物水平与肺癌血清组比较,差别均有统计学意义(P<0.05)。肺癌胸水组中CEA、CYFRA21-1、CA125的含量远远高于肺癌血清组(7～80倍)(P<0.01),相比与正常对照组更是有200倍以上的增高(P<0.01),因此胸水中CEA、CYFRA21-1、CA125百倍左右的升高提示恶性肿瘤的存在。将93例癌性胸水和血清分为腺癌、鳞癌和小细胞癌。腺癌、鳞癌和小细胞癌胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物含量明显高于炎性胸水组(P<0.01);腺癌胸水组中CEA含量明显高于鳞癌和小细胞癌(P<0.01);鳞癌胸水组中CYFRA21-1含量明显高于腺癌和小细胞癌(P<0.01);小细胞癌胸水组中NSE和Pro-GRP含量明显高于腺癌和鳞癌(P<0.01)。CA125含量在胸水组中腺癌、鳞癌含量明显高于小细胞癌(P<0.01)。5种标志物单项及联合检测的灵敏度肺癌胸水组均高于肺癌血清组,肺癌胸水中5项联合检测后灵敏度可达99.11%。结论:肺癌组胸水中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物联合检测有利于良恶性胸水的鉴别诊断,联合检测可以提高肺癌诊断的灵敏度,当肿瘤标志物显著升高时,CEA可作为肺腺癌的肿瘤标志物;CYFRA21-1可作为肺鳞癌的肿瘤标志物;NSE和Pro-GRP可作为小细胞癌的肿瘤标志物;CA125可作为非小细胞肺癌的肿瘤标志物。

Objective：To investigate the relationship between carcinoembryonic antigen （CEA）, cancer antigen 125 （ CA125 ） ,cytokeratin 19 （ CYFRA21 - 1 ）, neuron - specific enolase （NSE） and Pro gastrin releasing pep-tide （ Pro - GRP） in the clinical diagnosis of lung cancer in order to improve the ability to identify benign and malig nant pleural effusion. Methods ：Pleural effusion and serum levels of CEA, CA125, CYFRA21 - 1 ,NSE and Pro GRP were measured by electrochemilunfinescence in 93 patients with lung cancer and 54 patients with pulmonary inflam matory diseases. Results：The mean levels of CEA, CA125, CYFRA21 - 1 ,NSE and Pro - GRP in the pleural effusion of lung cancer group were significantly higher than those in the inflamnlation group （ P 〈 0.05 ）. The levels of CEA, CYFRA21 - 1 and CA125 in the pleural effusion of lung cancer group were significantly higher than those in the pleu- ral effusion of infflammation group （ 20 - 600 times） （ P 〈 0.01 ）. CEA, CA125, CYFRA21 - 1, NSE and Pro - GRP in the pleural effusion of lung cancer group were significantly higher than those in the serum of lung cancer group （ P 〈 0.05）. The levels of CEA, CYFRA21 - 1 and CA125 in the pleural effusion of lung cancer group were significantly higher than those in the serum of lung cancer group （ P 〈 0.01 ） （7 - 80 times）, which was higher than that in the normal control group （ P 〈 0.01 ） （200 times）, so CEA, CYFRA21 - 1, CA125 in pleural effusion with 100 times higher prompted the presence of malignant tumors. 93 cases of cancerous pleural effusion and serum were divided into adenocarcinoma,squamous cell carcinoma and small cell carcinoma. The levels of CEA, CA125, CYFRA21 -1 ,NSE and Pro - GRP in adenocarcinoma, squamous cell carcinoma and small cell carcinoma in pleural effusion were signifi cantly higher than those in ilfflammatory pleural effusion group （ P 〈 0.01 ）. The level of CEA in pleural effusion of adenocarcinoma was significantly higher than that in squamous cell carcinoma and small cell carcinoma （ P 〈 0.01 ）. The content of CYFRA21 - 1 in squamous cell carcinoma was significantly higher than that in adenocarcinoma and small cell carcinoma （P 〈 0.01 ）. The levels of NSE and Pro -GRP in pleural effusion of small cell carcinoma were significantly higher than that in squamous cell carcinoma and adenocarcinoma （P 〈 0.01 ）. The content of CA125 in adenocarcinoma and squamous cell carcinoma was significantly higher than that in small cell carcinoma （ P 〈 0.01 ）. The sensitivities of the five kinds of markers in the pleural effusion of lung cancer group were higher than serum of the lung cancer group,and the sensitivity of the combined test was 99.11%. Conclusion：Combined detection of CEA, CA125, CYFRA21 - 1, NSE and Pro - GRP markers in pleural effusion of lung cancer is helpful to the differential di agnosis of benign and malignant pleural effusion. Combined detection can improve the sensitivity of diagnosis of lung cancer. Ascending, CEA can be used as tmnor marker of lung adenocarcinoma. CYFRA21 - 1 can be used as tmnor marker of lung squamous cell carcinoma, NSE and Pro - GRP can be used as tmnor markers of small cell carcinoma, CA125 can be used as the tumor markers of non - small cell lung cancer.