血清CYFRA21-1、CEA联合MMP-1和SAA在非小细胞肺癌检测中的价值分析

An Analysis of the Diagnostic Value of Serum CYFRA21-1,CEA Combined with MMP-1 and SAA in Non-small Cell Lung Cancer

目的探讨血清细胞角蛋白19片段(cytokeratin-19-fragment,CYFRA21-1)、癌胚抗原(carcinoembryonic antigen,CEA)、基质金属蛋白酶-1(matrix metalloproteinase-1,MMP-1)和血清淀粉样蛋白A(Serum amyloid protein A,SAA)水平在非小细胞肺癌(non-small cell lung cancer,NSCLC)检测中的价值。方法收集2013年1月至2016年12月期间入我院就诊的NSCLC患者160例作为病例组,同期收集我院收治的患有肺部良性疾病患者148例作为对照组。结果与对照组相比,NSCLC患者血清CYFRA21-1、CEA、MMP-1和SAA水平均增高,且差异具有统计学意义(P<0.05)。NSCLC患者血清MMP-1水平与淋巴结转移(P<0.001)和TNM分级(P=0.002)呈线性关联;血清SAA水平与淋巴结转移(P<0.001)呈线性关联。ROC曲线分析显示,血清CYFRA21-1、CEA、MMP-1和SAA在区分NSCLC与肺部良性疾病的灵敏度/特异度分别为:87.6%/76.3%、63.4%/68.3%、80.9%/94.7%和83.8%/86.5%;对应的临界值分别为:9.7ng/mL、4.9ng/mL、45.7pg/mL和28.4mg/L;联合血清CYFRA21-1、CEA、MMP-1和SAA在区分NSCLC与肺部良性疾病的灵敏度为91.5%,特异度为91.0%。Logistic回归多因素分析显示,在校正年龄、性别、吸烟史、饮酒史等因素影响后,血清高MMP-1和SAA水平仍是NSCLC发病的独立危险因素(P<0.05)。结论血清CYFRA21-1、CEA联合MMP-1和SAA对NSCLC具有潜在的诊断价值,有望为NSCLC的诊疗提供新的途径与思路。

Objective To investigate the diagnostic value of sertun cytokeratin 19 fragment （CYFRA21-1）, carcinoembryonic antigen （ CEA）, matrix metalloproteinase- 1 （ matrix metalloproteinase- 1, MMP- 1 ） and serum amyloid protein A（SAA） levels in patients with non-small cell lung cancer（NSCLC）. Methods 160 NSCLC patients from January 2013 to December 2016 were collected for the study, while148 patients with benign lung diseases were also enrolled as controls. Results The levels of serum CYFRA21-1 ,CEA,MMP-1 and SAA in NSCLC patients were significantly higher than those in controls （ P 〈 0.05 ）. The level of serum MMP- 1 in NSCLC patients was linearly associated with lymph node metastasis （P 〈 0. 001 ）and TNM grade （P = 0. 002）, and the level of SAA was linearly associated with lymph node metastasis （ P 〈 0. 001 ）. Receiver operator characteristic curve （ROC）analysis showed that the sensitivity/specificity of serum CYFRA21-1, CEA,MMP-1 and SAA in differentiating NSCLC from benign pulmonary were 87.6%/76.3% ,63.4%/ 68.3% ,80. 9%/94. 7% and 83. 8%/86. 5%, respectively. And the cutoff value were 9. 7ng/mL, 4.9ng/mL,45. 7pg/mL and 28. 4mg/L, respectively. The sensitivity and specificity of combined serum CYFRA21-1 ,CEA, MMP-1 and SAA in differentiating NSCLC from benign pulmonary were 91.5% and 91.0% ,respectively. Multivariate logistic regression analysis showed that high MMP-1 and SAA were independent risk factors of NSCLC after adjusting for age, gender, smoking and drinking. Conclusion Serum CYFRA21-1, CEA combined with MMP-1 and SAA have potential diagnostic value for NSCLC, which is expected to provide new methodology for the diagnosis and treatment of NSCLC.