血清CEA、CYFRA21-1联合ALP在非小细胞肺癌骨转移诊断中的应用

Application of Serum CEA,CYFRA21-1 Combined with ALP in the Diagnosis of Bone Metastasis of Non-small Cell Lung Cancer

目的探讨肿瘤标志物联合ALP在非小细胞肺癌骨转移中的诊断价值。方法选取非小细胞肺癌患者159例[骨转移组(n=82)、无骨转移组(n=77)]和83例肺炎患者(肺炎组)。检测血清CEA、CYFRA21-1和ALP的水平,记录年龄、性别等信息。采用Pearson相关分析评价各指标间的相关性。非小细胞肺癌患者骨转移的影响因素采用Logistic回归分析。采用受试者工作特征(ROC)曲线评价血清CEA、CYFRA21-1和ALP诊断非小细胞肺癌患者骨转移的价值。结果本研究共纳入159例非小细胞肺癌患者,未发生骨转移77例,发生骨转移82例,骨转移发生率为51.6%,腺癌与鳞状细胞癌骨转移发生率比较,差异无统计学意义(P>0.05)。骨转移组CEA、CYFRA21-1和ALP的水平均高于非骨转移组和肺炎组(P<0.05),非骨转移组血清CEA、CYFRA21-1和ALP的水平均高于肺炎组,差异有统计学意义(P<0.05)。ALP与CYFRA21-1、CEA呈正相关(r=0.278,P<0.01;r=0.343,P<0.01)。Logistic回归分析结果显示,CYFRA21-1、CEA和ALP是NSCLC患者发生骨转移的危险因素。ROC曲线结果显示,CEA、CYFRA21-1和ALP联合诊断非小细胞肺癌患者骨转移的曲线下面积(AUC)为0.829,95%CI:0.761~0.884,约登指数为0.512,敏感度和特异性分别为72.0%和79.2%。结论肿瘤标志物联合ALP在非小细胞肺癌患者骨转移的诊断中具有重要价值。

Objective To investigate the role of tumor markers combined with ALP in the diagnosis of bone metastasis in patients with non-small cell lung cancer(NSCLC).Methods A total of 159 patients with non-small cell lung cancer were enrolled in this study and pneumonia group(n=83).The levels of carcinoembryonic antigen(CEA),cytokeratin-19 fragment(CYFRA21-1)and alkaline phosphatase(ALP)were measured,information about NSCLC patients and pneumonia patients such as age,gender was collected from medical records.Pearson correlation analysis was used to evaluate the correlations between variables.Logistic regression analysis was used to analyze the influencing factors of bone metastasis in patients with NSCLC.Receiver operating characteristic(ROC)curve was used to evaluate the roles of CEA,CYFRA21-1 and ALP for the diagnosis of bone metastasis in patients with NSCLC.Results A total of 159 patients with NSCLC were included and divided into bone metastasis group(n=82)and non-bone metastasis group(n=77),with bone metastasis rate of 51.6%(82/159).There was no significant difference in the incidence of bone metastasis between adenocarcinoma and squamous cell carcinoma(P>0.05).The serum of CEA,CYFRA21-1 and ALP in patients with bone metastasis group were significantly higher than those with non-bone metastasis group and pneumonia group(P<0.05),and the patients with non-bone metastasis group were significantly higher than those in pneumonia group(P<0.05).There was a positive correlation between serum CEA,CYFRA21-1 and ALP(r=0.278,P<0.01;r=0.343,P<0.01).Logistic regression analysis showed that CYFRA21-1,CEA and ALP are the risk factors for bone metastasis in NSCLC patients.The results of receiver operating characteristic curve(ROC)showed that the area under the curve(AUC)of ALP combined with CEA,CYFRA21-1 was 0.829,95%CI:0.761-0.884,using a Youden index of 0.512 resulted in 72.0%sensitivity and 79.2%specificity,higher than single diagnosis.Conclusion CEA,CYFRA21-1and ALP plays a role in the diagnosis of bone metastasis for patients with NSCLC.