血清肿瘤标志物联合检测在肺癌诊断及分型中的价值

Study on the value of combined detection of serum tumor markers in diagnosis and classification of lung cancer

目的分析癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白19片段(cytokeratin 19 fragment,CYFRA21-1)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、胃泌素释放肽前体(gastrin-releasing peptide precursor,ProGRP)等4项血清肿瘤标志物单独及联合检测在肺癌诊疗中的应用价值。方法选取首次确诊的肺癌患者134例(肺癌组)、同时期收治的肺部良性疾病患者120例(良性组)和健康体检者109例(对照组)作为研究对象。采用电化学发光法检测各组血清CEA、CYFRA21-1、NSE、ProGRP水平,采用非参数检验比较各指标水平并用受试者工作特征(ROC)曲线分析各项指标单独或联合使用对肺癌的诊断价值。结果肺癌组的4项肿瘤标志物水平均显著高于良性组和对照组(P<0.05);在肺癌组中,腺癌患者CEA水平高于鳞癌和小细胞癌,鳞癌患者CYFRA21-1水平高于腺癌和小细胞癌,小细胞癌患者NSE和ProGRP水平均高于腺癌和鳞癌,差异均有统计学意义(P<0.05);诊断肺腺癌、肺鳞癌、肺小细胞癌的曲线下面积(AUC)最大的标志物分别为:CEA(0.783)、CYFRA21-1(0.892)、NSE(0.948);4项肿瘤标志物联合检测诊断肺癌(总体)的曲线下面积AUC(0.903)、灵敏度(88.1%)、特异度(84.4%)明显高于各指标单独检测。结论肿瘤标志物CEA、CYFRA21-1、NSE、ProGRP对肺癌的诊断有一定的价值,并且对肺癌的病理分型有一定的意义,4项指标联合检测诊断肺癌优于单项检测。

Objective To investigate the value of combined detection of serum tumor markers,such as carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CyFRA21-1),neuron specific enolase(NSE)and Gastrin-releasing peptide precursor(ProGRP)in the diagnosis and treatment of lung cancer.Methods A total of 134 patients with lung cancer(lung cancer group),120 patients with benign lung disease(benign group)and 109 healthy subjects(control group)were selected as the research objects.Serum CEA,CyFRA21-1,NSE and ProGRP levels were determined by electrochemiluminescence.Non-parametric test was used to compare the levels of each index,and receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of each index alone or in combination for lung cancer.Results The levels of 4 tumor markers in lung cancer group were significantly higher than those in benign group and control group(P<0.05).In lung cancer group,CEA level of adenocarcinoma patients was higher than that of squamous cell carcinoma and small cell carcinoma,cyFRA21-1 level of squamous cell carcinoma was higher than that of adenocarcinoma and small cell carcinoma,NSE and ProGRP levels of small cell carcinoma were higher than that of adenocarcinoma and squamous cell carcinoma,the differences were statistically significant(P<0.05).The largest area under curve(AUC)in diagnosis of lung adenocarcinoma,lung squamous cell carcinoma and lung small cell carcinoma were CEA(0.783),CYFRA21-1(0.892)and NSE(0.948),respectively.The AUC(0.903),sensitivity(88.1%)and specificity(84.4%)of the four tumor markers combined in the diagnosis of lung cancer(total)were significantly higher than that of each indicator alone.Conclusion As tumor markers,CEA,CYFRA21-1,NSE and ProGRP have certain value for the diagnosis of lung cancer,and have certain significance for the pathological classification of lung cancer.The combined detection of the four indicators is better than the single detection.