细胞角质蛋白19片段抗原21-1、神经元特异性烯醇化酶和鳞状细胞癌抗原在非小细胞肺癌合并恶性胸腔积液患者中的表达及临床意义

Expression and clinical significance of cyto-keratin 19 fragment antigen 21-1,neuron specific enolase and squamous cell carcinoma antigen in patients with non-small cell lung cancer and malignant pleural effusion

目的探讨细胞角质蛋白19片段抗原21-1(CYFRA21-1)、神经元特异性烯醇化酶(NSE)和鳞状细胞癌抗原(SCC-Ag)在非小细胞肺癌(NSCLC)合并恶性胸腔积液患者中的表达及临床意义。方法选取107例NSCLC患者和130例健康体检者,分别作为研究组和对照组。根据是否合并恶性胸腔积液将NSCLC患者分为合并组和未合并组。比较研究组和对照组的CYFRA21-1、NSE和SCC-Ag水平,比较合并组和未合并组的CYFRA21-1、NSE和SCC-Ag水平,采用多元Logistic回归模型分析NSCLC患者合并恶性胸腔积液的影响因素,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析CYFRA21-1、NSE、SCC-Ag单独及三者联合检测对NSCLC患者合并恶性胸腔积液的预测价值。结果研究组患者的CYFRA21-1、NSE和SCC-Ag水平均明显高于对照组(P﹤0.01)。107例NSCLC患者中,合并胸腔积液69例,未合并胸腔积液38例,合并组患者的CYFRA21-1、NSE和SCC-Ag水平均明显高于未合并组(P﹤0.01)。单因素及多因素分析结果显示,血性胸腔积液、临床分期为Ⅲ~Ⅳ期及CYFRA21-1、NSE、SCC-Ag水平异常升高均是NSCLC患者合并恶性胸腔积液的危险因素(P﹤0.05)。ROC曲线分析结果显示,CYFRA21-1、NSE、SCC-Ag单独及三者联合检测预测NSCLC患者合并恶性胸腔积液的AUC分别为0.948、0.803、0.834及0.976,其中三者联合的预测价值最佳。结论NSCLC合并恶性胸腔积液患者中CYFRA21-1、NSE、SCC-Ag水平均异常升高,临床医师可通过加强监测这三项指标,有效预测恶性胸腔积液的发生。

Objective To explore the expression and clinical significance of cyto-keratin 19 fragment antigen 21-1(CYFRA21-1), neuron specific enolase(NSE) and squamous cell carcinoma antigen(SCC-Ag) in patients with non-small cell lung cancer(NSCLC) and malignant pleural effusion. Method A total of 107 NSCLC patients and 130 healthy subjects were selected into the study group and the control group, and NSCLC patients were divided into combined group and non-combined group based on presence of malignant pleural effusion. The levels of CYFRA21-1, NSE, and SCC-Ag in study group and control group were compared, the levels of CYFRA21-1, NSE, and SCC-Ag in combined group and non-combined group were compared. Multivariate Logistic regression was used to analyze the influencing factors of malignant pleural effusion in NSCLC patients. Receiver operating characteristic(ROC) curve and area under the curve(AUC) were used to analyze the value of CYFRA21-1, NSE, and SCC-Ag alone and combined detection in predicting the malignant pleural effusion of NSCLC patients. Result The levels of CYFRA21-1, NSE and SCC-Ag in the study group were significantly higher than those in the control group(P<0.01). In 107 NSCLC patients, 69 had pleural effusion, and38 had no pleural effusion, the levels of CYFRA21-1, NSE, and SCC-Ag in the combined group were significantly higher than those in the non-combined group(P<0.01). The univariate and multivariate analysis showed that bloody pleural effusion, the clinical stage of III-IV, the abnormal increase of CYFRA21-1, NSE and SCC-Ag were risk factors for malignant pleural effusion in NSCLC patients(P<0.05). The ROC curve showed AUC of single CYFRA21-1, NSE, SCC-Ag and combined detection in predicting malignant pleural effusion in NSCLC patients was 0.948, 0.803, 0.834 and 0.976, respectively, and the predictive value of combined detection was the best. Conclusion CYFRA21-1, NSE, and SCC-Ag are abnormally increased in NSCLC patients with malignant pleural effusion. Clinicians can strengthen monitoring of the three indicators to effectively predict the occurrence of malignant pleural effusion.