ProGRP、CYFRA21-1和胱抑素C联合检测对不同病理类型肺癌的诊断价值

The diagnostic value of combined detection of ProGRP,CYFRA21-1 and cystatin C for different pathological types lung cancer

目的探讨血清胃泌素释放肽前体(ProGRP)、细胞角蛋白19片段(CYFRA21-1)和胱抑素C(CysC)联合检测对肺癌诊断的价值。方法81例肺癌患者根据病理分型分为腺癌组(24例)、鳞癌组(28例)、小细胞肺癌组(29例),选择同期59例肺良性病变患者纳入肺良性病变组,60例健康体检者纳入健康对照组,均检测血清中的ProGRP、CYFRA21-1和CysC水平,并进行比较,采用Spearman法分析血清ProGRP、CYFRA21-1与CysC的相关性,并采用受试者工作特征(ROC)曲线分析三者联合检测对肺癌诊断的灵敏度、特异度、阴性预测值、阳性预测值。结果腺癌组、鳞癌组和小细胞肺癌组CYFRA21-1水平高于肺良性病变组和健康对照组,差异有统计学意义(P<0.05)。小细胞肺癌组的ProGRP水平高于其他4组,差异有统计学意义(P<0.05)。鳞癌组和小细胞肺癌组的CysC水平高于其余3组,差异有统计学意义(P<0.05)。小细胞肺癌组中,ProGRP与CysC呈显著正相关(r=0.641)。CYFRA21-1、ProGRP、CysC及三者联合检测诊断肺癌的AUC(95%CI)分别为0.848(0.778~0.903)、0.670(0.585~0.747)、0.920(0.862~0.959)和0.964(0.918~0.988),联合检测的AUC最大,且阳性预测值为95.9%,阴性预测值为84.9%。结论血清ProGRP、CYFRA21-1和CysC检测对肺癌病理分型、鉴别诊断有一定的参考价值,三者联合检测可为临床诊断肺癌提供灵敏度、特异度高的诊断手段。

Objective To explore the value of combined detection of serum gastrin-releasing-peptide precursor(ProGRP),cytokeratin 19 fragment(CYFRA21-1)and cystatin C(CysC)in the diagnosis of lung cancer.Methods A total of 81 cases of lung cancer patients were enrolled,including 24 cases in adenocarcinoma group,28 cases in squamous cell carcinoma group,29 cases in small cell lung cancer group.Other 59 cases in benign lung disease group and 60 cases in normal control group.The levels of ProGRP,CFRA21-1 and CysC in serum were detected and compared.The correlation of serum ProGRP,CYFRA21-1 and CysC were analyzed by Spearman method,and the sensitivity,specificity,positive predictive value,negative predictive value of the combination of the three indicators were analyzed by ROC curve.Results The levels of CYFRA21-1 in adenocarcinoma group,squamous cell carcinoma group and small cell lung cancer group were higher than those in benign lung disease group and normal control group(P<0.05).ProGRP in small cell lung cancer group was higher than those of other groups(P<0.05).Compared with the other three groups,the levels of CysC in squamous cell carcinoma group and small cell lung cancer group were higher(P<0.05).ProGRP correlated positively with CysC in small cell lung cancer group(r=0.641).The AUC(95%CI)of CYFRA21-1,ProGRP,CysC for diagnosis of lung cancer were 0.848(0.778-0.903),0.670(0.585-0.747),0.920(0.862-0.959)respectively.The maximum AUC of combined diagnosis was 0.964(0.918-0.988),the positive predictive value and the negative predictive value were 95.9%and 84.9%respectively.Conclusion The detection of serum ProGRP,CYFRA21-1 and CysC have certain reference value for pathological classification and differential diagnosis of lung cancer.The combined detection of the three indicators could provide a high sensitivity and specificity diagnostic means for clinical diagnosis of lung cancer.