肺实质性占位病变患者血清肿瘤标志物测定的临床意义

The clinical significance of the determination of serum tumor markers in patients with pulmonary parenchyma occupying lesions

目的探讨4种常用肺血清肿瘤标志物对肺实质性占位病变鉴别诊断的临床意义。方法选取2015年1月至2016年6月郑州大学第一附属医院收治的360例肺实质性占位病变初诊入院患者,检测治疗前外周静脉血癌胚抗原(CEA)、糖类抗原(CA125)、细胞角蛋白19片段抗原21-1(Cyfra21-1)、神经元特异性烯醇化酶(NSE)表达水平,评价其单独与联合检测诊断肺癌的敏感性和特异性。结果肺癌组CEA、CA125、Cyfra21-1、NSE表达水平均高于良性组,差异有统计学意义(P <0. 05)。Ⅲ+Ⅳ期肺癌患者血清CEA、CA125、Cyfra21-1、NSE表达水平高于Ⅰ+Ⅱ期,差异有统计学意义(P <0. 05)。Ⅰ+Ⅱ期肺癌组患者血清CA125表达水平与良性组比较,差异无统计学意义(P> 0. 05);血清CA125表达水平在肺癌不同病理类型间比较,差异无统计学意义(P> 0. 05)。联合CEA、Cyfra21-1及NSE诊断肺癌的敏感性为80. 7%,特异性为81. 4%,ROC曲线下的面积(AUCROC)为0. 887。结论血清肿瘤标志物CEA、Cyfra21-1及NSE联合检测在鉴别肺部实质性占位病变良恶性上有较大优势。

Objective To explore the clinical significance of careinoembryonic antigen（CEA）,carbohydrate antigen 125（CA125）,cytokeratin 19 fragment antigen 21-1（Cyfra21-1）and neuron specific enolase（NSE）in the diagnosis of pulmonary parenchyma occupying lesions.Methods A total of 360 patients with lung mass occupying lesions were enrolled in the First Affiliated Hospital of Zhengzhou University from January of 2015 to June of 2016. The expression levels of CEA, CA125, Cyfra21-1 and NSE in peripheral venous blood were detected before treatment. The sensitivity and specificity of single or combination lung cancer-related serum biomarkers were analyzed for the diagnosis of lung cancer.Results The expression levels of CEA, CA125, Cyfra21-1 and NSE in lung cancer group were significantly higher than that in benign group （ P 〈0.05 ）. The levels of CEA, CA125, Cyfra21-1 and NSE had the higher positive rate for Ⅲ and Ⅳ stage of lung cancer（ P 〈0.05 ）. The level of CA125 in patients with Ⅰand Ⅱ stage of lung cancer and benign group had no statistical significance （ P 〉0.05 ）, and it had no statistical significance in different pathological types of lung cancer （ P 〉0.05 ）. The diagnostic sensitivity and specificity of the panel including CEA、Cyfra21-1 and NSE to lung cancer was 80.7%, 81.4%, and the AUC ROC was 0.887.Conclusion The joint detection of tumor markers CEA, cyfra21-1 and NSE has a great advantage in distinguishing benign and malignant lung lesions.