不同肿瘤标志物对肺恶性肿瘤的诊断及鉴别诊断价值

Value of various tumor markers in diagnosis and differential diagnosis of pulmonary malignant tumor

目的探讨细胞角蛋白19片段21-1(CYFRA21-1)、神经元特异性烯醇化酶(NSE)、鳞状细胞癌(SCC)相关抗原、胃泌素释放肽前体(Pro GRP)、人附睾蛋白4(HE4)对肺恶性肿瘤的诊断及鉴别诊断价值。方法选择小细胞肺癌患者、非小细胞肺癌患者、肺良性疾病患者、健康体检者各100例。检测各组血清CYFRA21-1、NSE、SCC相关抗原、Pro GRP、HE4水平。应用受试者工作特征曲线分析各肿瘤标志物鉴别诊断肺恶性肿瘤和良性疾病、小细胞肺癌和非小细胞肺癌的效能。结果肺恶性肿瘤组各肿瘤标志物水平均高于肺良性疾病组和健康对照组(均P<0.05)。与非小细胞肺癌组相比,小细胞肺癌组血清NSE和Pro GRP水平升高,血清CYFRA21-1和SCC相关抗原水平降低(均P<0.05)。HE4、CYFRA21-1、NSE、Pro GRP、SCC相关抗原鉴别诊断肺恶性肿瘤和肺良性疾病的效能依次降低;SCC相关抗原、NSE、Pro GRP、CYFRA21-1鉴别诊断小细胞肺癌和非小细胞肺癌的效能依次降低。结论 HE4、CYFRA21-1、NSE、Pro GRP、SCC相关抗原对肺恶性肿瘤的诊断及鉴别诊断均具有一定价值。

Objective To investigate the value of cytokeratin-19-fragment 21-1 （ CYFRA21-1 ）, neuron-specific enolase （ NSE）, squamous cell carcinoma（ SCC ）-related antigen, pro-gastrin-releasing peptide （ProGRP） and human epididymis protein 4 （HE4） in the diagnosis and differential diagnosis of pulmonary malignant tumor. Methods One hundred cases of small cell lung cancer, 100 of non-small cell lung cancer, 100 of lung benign disease, and 100 healthy subjects receiving check-up were enrolled. The levels of serum CYFRA21-1 ,NSE,SCC-related antigen,ProGRP and HE4 were detected in each group. And the efficiency of various tumor markers for differential diagnosis of pulmonary malignant tumor, benign disease, small cell lung cancer and non-small cell lung cancer was analyzed by using receiver operating characteristic curve. Results The levels of various tumor markers in the pulmonary malignant tumor group were all higher than those in the lung benign disease group and healthy control group （ all P 〈 0.05 ）. Compared with the non-small cell lung cancer group, the levels of serum NSE and ProGRP increased,while the levels of serum CYFRA21-1 and SCC-related antigen decreased in the small cell lung cancer group（ all P 〈0.05 ）. The efficacy of HE4, CYFRA21-1 ,NSE,ProGRP and SCC-related antigen for differential diagnosis of pulmonary malignant tumor and lung benign disease decreased in turn;and the efficacy of SCC-related antigen, NSE, ProGRP and CYFRA21-1 for differential diagnosis of small cell lung cancer and non-small cell lung cancer decreased in turn. Conclusion HE4, CYFRA21-1 ,NSE,ProGRP and SCC-related antigen are valuable in the diagnosis and differential diagnosis of pulmonary, malignant tumor to some extent.