5种肿瘤标志物在非小细胞肺癌中的诊断价值

Diagnostic value of five tumor markers in non-small cell lung cancer

目的分析血清铁蛋白(SF)、神经原特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(SCC)、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)5种肿瘤标志物在非小细胞肺癌(NSCLC)中的诊断价值。方法选择2019年9月至2020年8月云南省肿瘤医院收治的212例患者为研究对象,将111例NSCLC患者作为试验组,101例肺良性肿瘤患者作为对照组。采用全自动电化学发光分析仪及其相应的配套试剂检测两组的SF、NSE、CEA和CYFRA21-1水平,采用化学发光分析仪及相应的配套试剂盒检测两组的血清SCC水平。结果试验组的SF、NSE、SCC、CEA、CYFRA21-1水平高于对照组,差异均具有统计学意义(P<0.05)。鳞癌组SCC、CYFRA21-1水平高于腺癌组,差异具有统计学意义(P<0.05)。Ⅲ+Ⅳ期患者SCC、CEA、CYFRA21-1水平高于Ⅰ+Ⅱ期患者,差异具有统计学意义(P<0.05)。淋巴结发生转移患者(N_(1)+N_(2)+N_(3)组)的SF、CYFRA21-1水平高于无淋巴结转移患者(N0组),差异具有统计学意义(P<0.05)。试验组不同病理类型患者的SF、NSE、SCC、CEA、CYFRA21-1阳性率均高于对照组,差异具有统计学意义(P<0.05);腺癌组的SF阳性率最高,为62.16%;鳞癌组的CYFRA21-1阳性率最高,为70.27%。单项检测时,SF的灵敏度最高,为90.02%,而SCC的灵敏度最低,为23.87%;CYFRA21-1的AUC最大,其次为SF,而SCC的AUC最小。联合检测的灵敏度高于任何一项指标,为90.99%;联合检测的AUC为0.93(95%CI:0.88~0.96),其AUC、95%CI均高于单独检测的任一指标,差异具有统计学意义(P<0.05)。结论SF、SCC、NSE、CEA、CYFRA21-1在NSCLC中高表达,对评估临床病理特征具有重要的临床价值,5种肿瘤标志物联合检测可提高NSCLC的诊断价值。

Objective To analyze the diagnostic value of serum ferritin(SF),neurogen specific enolase(NSE),squamous cell carcinoma antigen(SCC),carcinoembryonic antigen(CEA)and cytokeratin 19 fragment(CYFRA21-1)in the non-small cell lung cancer(NSCLC).Methods A total of 212 patients admitted in Yunnan cancer hospital from September 2019 to August 2020 were selected as the study objects,111 patients with NSCLC were selected as experimental group,and 101 patients with benign lung tumors were selected as control group.The levels of SF,NSE,CEA and CYFRA21-1 in the two groups were detected by automatic electrochemiluminescence analyzer and corresponding reagents,and the level of serum SCC in the two groups were detected by chemiluminescence analyzer and corresponding kits.Results The levels of SF,NSE,SCC,CEA and CYFRA21-1 in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of SCC and CYFRA21-1 in the squamous carcinoma group were higher than those in the adenocarcinoma group,and the differences were statistically significant(P<0.05).The levels of SCC,CEA and CYFRA21-1 in patients with stage Ⅲ+Ⅳ were higher than those in patients with stage Ⅰ+Ⅱ,and the differences were statistically significant(P<0.05).The levels of SF and CYFRA21-1 in patients with lymph node metastasis(N_(1)+N_(2)+N_(3) group)were higher than those in patients without lymph node metastasis(N0 group),and the differences were statistically significant(P<0.05).The positive rates of SF,NSE,SCC,CEA and CYFRA21-1 of patients with different pathological types in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05);the positive rate of SF in the adenocarcinoma group was the highest,accounting for 62.16%;the positive rate of CYFRA21-1 in the squamous carcinoma group was the highest,accounting for 70.27%.In single detection,the sensitivity of SF was the highest,accounting for 90.02%,while that of SCC was the lowest,accounting for 23.87%;the AUC of CYFRA21-1 was the largest,followed by SF,while the AUC of SCC was the smallest.The sensitivity of combined detection was 90.99%,which was higher than any other indexes;the AUC of combined detection was 0.93(95%CI:0.88-0.96),and its AUC and 95%CI were higher than those of single detection,the differences were statistically significant(P<0.05).Conclusion SF,SCC,NSE,CEA and CYFRA21-1 are highly expressed in NSCLC,which has important clinical value in evaluating clinicopathological features.The combined detection of five tumor markers can improve the diagnostic value of NSCLC.