联合检测五种肿瘤标志物评价肺癌治疗疗效

Combi ned detecti on of five tumor markers evaluti ng treat me nt effect of lung can cer

目的:探讨分析五种肿瘤标志物对肺癌疗效的评价作用.方法:选取2015年1月.2016年7月110例患者(肺癌组70例、肺良性疾病组40例)用电化学发光法检测血清肿瘤标志物的水平,主要检测的项目为血清糖链抗原125(CA125),血清癌胚抗原(CEA),细胞角蛋白19片段(CYFRA21-1),神经元特异性烯醇化酶(NSE),鳞状细胞癌抗原(SCCA).结果:肺癌治疗前组CA125[32.35(13.43,85.42)]、CEA[859(3.48,33.05)]、CYFRA21-1(3.87(2.60,10.81)],NSE[16.S5(12.47,32.72)1及肺癌治疗后组血清CA125[26.21(12.56,48.37)]、CEA[8.36(3.23,30.43)]、CYFRA21-1[3.28(2.18,5.33)]、NSE[15.87(12.23,21.7)]高于肺良性疾病组CA125[15.43(9.95,27.93)]、CEA[2.18(1.60,3.28)]、CYFRA21T[2.09(1.69,3.24)]、NSE[13.62(11.20,16.50)],有显著差异(P<0.05)与肺癌治疗后组相比,肺癌治疗前组血清肿瘤标志物CA125、CEA,CYFRA21-1、NSE明显增高,有显著差别(P<0.05)。而SCCA在三组比较中无明显统计学意义(P>0.05):比较不同肺癌类型和病理类型肺癌患者阳性率得出:腺癌患者和鳞癌患者血清肿瘤标志物CEA阳性率比较有统计学意义(x^2=8236,P=0.009,P<0.05),而血清肿瘤标志物CA125(x^2=0.186,P=0.487)、NSE(x^2=0.157,P=0.491)、CYFRA21-1(x^2=0333,P=0.419)xSCCA(x^2=1.490,P=0.206)比较无统计学意义;小细胞癌患者和非小细胞癌患者的CEA(x^2=4.375,P=0.037)、NSE(x^2=20.543,P=0.000)、SCCA(x^2=3.678,P=(W49)三种肿瘤标志物阳性率比较有统计学意义(P<0.05),而CA125(x^2=0.155,P=0.456)、CYFRA21-1(x^2=0.430,P=0.354)比较无统计学意义(P>0.05):NSE在小细胞肺癌中高表达(P=0.000),CEA在腺癌中高表达(P=0.009),SCCA在鳞癌中高表达(P=0.049),(P<0.05具有统计学意义);比较各种血清肿瘤标志物单项及联合检测结果得出:联合检测CA125、CEA、CYFKA21-1.NSE的灵敏度(灵敏度98.57%)显著高于各项单项检测(CA125:45.71,CEA:60.00,NSE:44.29,CYFRA21-1:57.14,SCCA:24.29),比较有统计学意义(P<0.05);而联合检测CA125、CEA、CYFRA21-1、NSE的特异度(特异度37.14%)几乎全部低于各项卒项检测(CA125:85.71,CEA:71.43,NSE:67.23,CYFRA21-1:72.27,SCCA:18.49),比较无统计学意义.结论:血清肿瘤标志物CA125,CEA,NSE,CYFRA21-1、SCCA对肺癌的治疗疗效评估起到重要作用,为临床医师判断治疗效果提供了重要依据.

Objective: To evaluate 5 kinds of serum tumor markers for the treatment efficacy of lung cancer. Methods: A total of 110 patients were recruited (70 in the lung cancer group and 40 in the benign lung disease group) from January 2015 to July 2016. The electrochemical luminescence instrnnient was applied to detect expression levels of Serum Tumor Markers .The main test items were carbohydrate antigen 125 (CAI25), carcino-embryonic antigen (CEA), cytokeratin 19 soluble fragments (CYFKA21-1), neuron specific enolase (NSE), and squamous cell carcinoma antigen (SCCA). Results: The expression levels of serum CAI 25 [26.21 (12.56,48.37)]、 CEA [8.36 (3.23,30.43)]、CYFRA21-1 [3.28 (2.18,5.33)]. NSE [15.87 (12.23^1.17)] in lung cancer treated group and CAI25 [32.35 (13.43,85.42)]、CEA [8.59 (3.48,33.05)] xCYFRA21 -1 [3.87 (2.60,10.81)]、NSE [ 16.85 (12.47,32.72)) in lung cancer without treatment group were higher than the benign lung disease group CAI25 115.43 (9.95,27.93)]、CEA [2.18 (1.60,3.28)]、CYFRA21-1 [2.09 (1.69,3.24)]、 NSE 113.62 (11.20,16.50)], the differences were significant (P=<0.05);Compared with the group after lung cancer treatment, semni tumor markers CA125, CEA, cyfra21-1 and NSE were significantly increased in the group before lung cancer creatnient (P<0.05), while such area of SCCA below 0.5 had no diagnostic value (P>0.05): It's significant to compare the positive rate of semni tumor marker CEA in patients with Adenocarcinoma and Squamous cell carcinoma ( x^2=8.236, P=0.009, PV).05).While the serum tumor markers CAI25 ( x^2=0.186, P=0.487)、NSE ( x^2=0.157, P=0.491)、CYFKA21-1 (x^2 =0.333, P =0.419)、SCCA (x^2 =1.490, P=0,206) were not statistically significant (P>0.05). The positive rates of three tumor markers of CEA (P=0.037)、NSE (P=0.000)、SCCA (P=0.049) in patients with small cell carcinoma and non small cell carcinoma were statistically significant (P<0.05). The serum tumor markers C'A 125 (x^2=0.155,P=0.456)、CYFKA21-1 (x^2=0.430, P=0.354) were not statistically significant (P>0.05). To compare the positive rate of lung cancer patients with different lung cancer types and pathological types :NSE was highly expressed in small cell lung cancer (P=0.000), CEA was highly expressed in adenocarcinoma (P=0.009) and SCCA was highly expressed in squamous cell carcinoma (P=0.049)(P<0.05, the differences were statistically significant). Through a variety of serum tumor markers and the results of a sin gle joint test results obtained : the sensitivity of combined detection of CA125、CEA、CYFRA21-1、NSE (these nsitivity is 98.57%) were significantly higher than that of single item test (CA125:45.71, CEA:60.00, NSE:44.29, CYFKA21 -1:57.14, SCCA:24.29), the comparison was statistically (P<0.05). The specificity of joint detection of CAI 25, CEA, CYFRA21-1、NSE (specificity 37.14%) was almost all lower than those of individual tests (CAI 25:85.71, CEA:71.43, NSE:67.23, CYFKA21 -1:72.27, SCCA:18.49), and there is no statistically significance (P>0.05). Conclusion: Serum tumor markers CA125 . CEA , CYFRA21-1、NSE、SCCA play significant roles in the treatment of lung cancer and provide important basis for the clinician to judge the therapeutic effect.