肿瘤标志物联合检测在肺恶性肿瘤诊断中的应用

Application of combined detection of tumor markers in diagnosis of lung malignant tumors

目的 研究肿瘤标志物联合检测在肺恶性肿瘤诊断中的应用。方法 选择2020年2月—2023年2月在淄博市市立医院就诊的92例肺恶性肿瘤患者和90例健康体检者作为研究对象,分别纳入疾病组和对照组。应用电化学发光免疫分析法检测两组受检者和不同类型肺恶性肿瘤患者的血清癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)。绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),比较上述指标单独与联合检测对肺恶性肿瘤的诊断效能。结果 疾病组的CEA、NSE、CYFRA21-1水平均显著高于对照组[CEA(μg/L):5.06(2.40,9.83)比2.16(1.58,2.69);NSE(μg/L):15.83(12.52,21.22)比12.76(11.65,14.00);CYFRA21-1(μg/L):3.30(2.02,6.55)比2.29(1.80,3.10);均P <0.05]。疾病组中,肺腺癌患者的CEA水平显著高于肺鳞癌、小细胞肺癌患者[μg/L:8.40(3.88,13.41)比3.33(2.22,6.23)、3.46(2.24,6.25),均P <0.05]。小细胞肺癌患者的NSE水平显著高于肺腺癌、肺鳞癌患者[μg/L:22.74(14.69,40.04)比15.11(12.60,19.52)、13.08(11.81,16.90),均P <0.05]。肺鳞癌患者的CYFRA21-1水平显著高于肺腺癌、小细胞肺癌患者[μg/L:5.63(3.29,10.12)比2.93(2.05,8.58)、2.61(1.81,4.32),均P <0.05]。不同类型肺恶性肿瘤患者的肿瘤标志物联合检测阳性检出率比较差异均无统计学意义;腺癌患者的联合检测阳性率显著高于NSE、CYFRA21-1单独检测(84.21%比39.47%、44.74%,均P <0.05),鳞癌患者的联合检测阳性率显著高于CEA、NSE单独检测(87.50%比33.33%、29.17%,均P <0.05),小细胞肺癌患者的联合检测阳性率显著高于CEA、CYFRA21-1单独检测(86.67%比33.33%、36.67%,均P <0.05);与单项检测比较,CEA、NSE、CYFRA21-1三项联合检测的诊断效能最高,AUC为0.907,95%可信区间(95%CI)为0.858~0.957。结论 CEA、NSE、CYFRA21-1联合检测应用于肺恶性肿瘤诊断中有利于明确病理类型,提高诊断率,能提升临床诊疗水平。

Objective To study the application of combined detection of tumor markers in the diagnosis of lung malignant tumors.Methods A total of 92 patients with pulmonary malignancies and 90 healthy subjects treated in Zibo Municipal Hospital from February 2020 to February 2023 were selected as research objects,and included into disease group and control group,respectively.Electrochemiluminescence immunoassay was applied to detecting serum carcinoembryonic antigen(CEA),neuron specific enolase(NSE)and cytokeratin 19 fragment antigen 21-1(CYFRA21-1)in two groups and patients with different types of lung malignancies.The receiver operator characteristic(ROC)curve was drawn and the area under ROC curve(AUC)was calculated to compare the diagnostic efficacy of the above indicators for lung malignant tumors,both individually and in combination.Results The levels of CEA,NSE and CYFRA21-1 in disease group were higher than those in control group[CEA(μg/L):5.06(2.40,9.83)vs.2.16(1.58,2.69);NSE(μg/L):15.83(12.52,21.22)vs.12.76(11.65,14.00);CYFRA21-1(μg/L):3.30(2.02,6.55)vs.2.29(1.80,3.10);all P<0.05].In disease group,the CEA level in patients with adenocarcinoma was higher than those in patients with lung squamous cell carcinoma and small cell lung carcinoma[μg/L:8.40(3.88,13.41)vs.3.33(2.22,6.23),3.46(2.24,6.25),both P<0.05].The NSE level in patients with small cell lung carcinoma was higher than those in patients with adenocarcinoma and squamous cell lung carcinoma[μg/L:22.74(14.69,40.04)vs.15.11(12.60,19.52),13.08(11.81,16.90),both P<0.05].The CYFRA21-1 level in patients with lung squamous cell carcinoma was higher than those in patients with lung adenocarcinoma and small cell lung carcinoma[μg/L:5.63(3.29,10.12)vs.2.93(2.05,8.58),2.61(1.81,4.32),both P<0.05].There was no statistically significant difference in the positive rate of tumor markers in patients with different types of lung malignant tumors.The positive rate of combined detection in patients with adenocarcinoma was higher than those of NSE and CYFRA21-1 alone(84.21%vs.39.47%,44.74%,both P<0.05),while the positive rate of combined detection in patients with squamous cell lung carcinoma was higher than those of CEA and NSE alone(87.50%vs.33.33%,29.17%,both P<0.05).The positive rate of combined detection in patients with small cell lung carcinoma was higher than those of CEA and CYFRA21-1 alone(86.67%vs.33.33%,36.67%,both P<0.05).Compared with single detection,the diagnostic efficiency of CEA,NSE and CYFRA21-1 combined detection was the highest,AUC was 0.907 and 95%confidence interval(95%CI)was 0.858-0.957.Conclusion The combined detection of CEA,NSE and CYFRA21-1 in the diagnosis of lung malignant tumors is beneficial for clarifying the pathological type,improving the diagnostic rate,and contributing to the improvement of clinical diagnosis and treatment level.