五种血清肿瘤标志物在肺癌诊断中的临床应用

Clinical application of five kinds of tumor markers in serum in the diagnosis of lung cancer

目的探讨神经元特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(SCC-Ag)、铁蛋白(SF)、胃泌素释放肽前体(Pro-GRP)、CA125五种血清肿瘤标志物对肿瘤诊断的临床意义。方法采用回顾性分析,选择2014年11月至2016年8月四川绵阳四○四医院收治的肺部疾病患者135例,根据组织病理学结果,患者分为肺良性病变组(n=78)和肺癌组(n=57)。另外选择同期于四川绵阳四○四医院体检中心进行体检的健康志愿者65例,作为对照组。采用电化学法检测血清中NSE、SCC-Ag、SF、Pro-GRP、CA125的水平,分析其与肺癌类型和病理分期的联系,同时比较单项肿瘤标志物检测与五种肿瘤标志物联合检测对肺癌的诊断意义,另外分析这五种肿瘤标志物表达情况的相关性。结果三组受试者血清中NSE、SCC-Ag、SF、Pro-GRP及CA125的水平及阳性表达率之间差异具有统计学意义(P<0.05);肺良性病变组和肺癌组患者血清中NSE、SCC-Ag、SF、Pro-GRP及CA125的水平及阳性表达率均明显高于对照组(P<0.05);NSE和Pro-GRP在小细胞肺癌患者血清水平明显高于对照组,SCC-Ag在鳞癌患者血清水平显著高于对照组,SF在鳞癌、腺癌和小细胞癌患者血清水平明显高于对照组,CA125在鳞癌和腺癌患者血清水平显著高于对照组,且差异均具有统计学意义(P<0.05);NSE、SCC-Ag、SF、Pro-GRP及CA125在Ⅰ~Ⅱ期、Ⅲ期和Ⅳ期的阳性表达率均明显高于对照组(P<0.05);与五种肿瘤标志物联合检测相比,单项肿瘤标志物检测的准确性、敏感性及阴性预测值明显下降(P<0.05),而特异性和阳性预测值方面差异均无统计学意义(P>0.05),另外,各单项肿瘤标志物的诊断标准之间差异也无统计学意义(P>0.05);肺癌患者血清中五种肿瘤标志物水平之间存在显著的正相关(P<0.05)。结论血清中NSE、SCC-Ag、SF、Pro-GRP及CA125可以用于诊断肺癌的诊断,同时可以用于鉴别肺癌分型及病理分期,五种血清肿瘤标志物具有密切联系,联合检测具有较高的临床意义,值得在临床推广。

Objective To evaluate the clinical significance of five kinds of tumor markers [neuron-specific enolase（NSE）,squamous cell carcinoma antigen（SCC-Ag） and ferritin in serum（SF）,pro-gastrin-releasing peptide（Pro-GRP）,and CA125] in serum of tumor diagnosed. Methods With the retrospective analysis,according to the results of the histopathological,135 cases of patients in Sichuan Mianyang404 Hospital from November 2014 to August 2016 were divided into lung benign lesion group（n = 78） and lung cancer group（n = 57）,in addition,65 cases of health volunteers in Sichuan Mianyang 404 Hospital physical examination center in the same period were treated as control group.The levels of serum NSE,SCC-Ag,SF,Pro-GRP,CA125 were detected by electrochemical method. The contact with lung cancer types and pathological staging was analyzed,at the same time the diagnosis significance of a single tumor marker and combined detection of lung cancer was compared. The correlation of 5 kinds of tumor markers in different situation was analyzed. Results The differences of levels of serum NSE,SCC-Ag,SF,Pro-GRP,CA125 of three groups of subjects and positive expression rate had statistical significance（P〈0. 05）; the levels of serum NSE,SCC-Ag,SF,Pro-GRP,CA125 and positive expression rate of lung benign lesions and lung cancer group were significantly higher than control group（P〈0. 05）. The levels of serum NSE and Pro-GRP in small cell lung cancer patients were significantly higher than those of the control group,and serum levels of SCC-Ag in the squamous carcinoma-patients was significantly higher than the control group. The levels of SF in squamous carcinoma,adenocarcinoma and small cell carcinoma patients was higher significantly than the control group,and the levels of CA125 in squamous carcinoma and adenocarcinoma patients was significantly higher than that of control group,and the differences were statistically significant（P〈0. 05）. The positive expression rate of NSE,SCC-Ag,SF,Pro-GRP,CA125 in Ⅰ-Ⅱ stage,stage Ⅲ and Ⅳ were significantly higher in control group（P〈0. 05）. Compared with the detection of five kinds of tumor markers,the accuracy,sensitivity and negative predictive value of single tumor markers significantly decreased（P〈0. 05）,while the differences of the specificity and positive predictive value were not statistical significant（P〉0. 05）. In addition,the difference between the diagnostic criteria for each single detection index was not statistically significant（P〉0. 05）. There was significant positive correlation among five kinds of tumor markers levels in serum of patients with lung cancer（P〈0. 05）. Conclusion NSE,SCC-Ag,SF,Pro-GRP,CA125 in serum can be used to diagnosis lung cancer,and can be used to identify lung cancer classification and pathological staging. There have close correlation among 5 kinds of serum tumor markers. Joint diagnosis has high clinical significance,which is worth popularizing in clinic.