血清肿瘤标志物联合检测在肺癌诊断中的价值研究
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摘要
目的探讨血清肿瘤标志物联合检测在肺癌诊断中的价值。方法采用电化学发光免疫分析法检测86例肺癌患者(肺癌组)、92例肺部良性病变患者(肺良性病变组)和96例健康体检者(健康对照组)的血清神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCCAg)、糖类抗原125(CA125)及细胞角质蛋白19片段抗原21-1(CYFRA21-1)水平。对比3组受试者血清肿瘤标志物水平,并比较不同病理类型肺癌患者的血清肿瘤标志物水平及阳性率、不同临床分期肺癌患者的血清肿瘤标志物水平、各种血清肿瘤标志物单项或5项联合检测在肺癌诊断中的价值。结果肺癌组患者的血清NSE、CEA、SCCAg、CA125、CYFRA21-1水平均高于肺良性病变组和健康对照组(P﹤0.05);小细胞肺癌患者的NSE水平及阳性率均高于腺癌患者和鳞癌患者(P﹤0.05),腺癌患者的CEA、CA125水平及CEA阳性率均高于鳞癌患者和小细胞肺癌患者(P﹤0.05),鳞癌患者的SCCAg、CYFRA21-1水平及SCCAg、CYFRA21-1、CA125阳性率均高于腺癌患者和小细胞肺癌患者(P﹤0.05);T3期肺癌患者的NSE、CEA、SCCAg、CA125、CYFRA21-1水平均高于T_1期(P﹤0.05),T_2期肺癌患者的NSE、CEA、CYFRA21-1水平均高于T_1期(P﹤0.05);5项肿瘤标志物联合诊断肺癌的灵敏度、阴性预测值均高于单项诊断,但其特异度仅为81.52%,阳性预测值仅为81.91%。结论不同病理类型及临床分期的肺癌患者肿瘤标志物水平存在较大差异;在肺癌诊断中单项血清肿瘤标志物检测存在一定的局限性,联合检测可提高肺癌诊断的灵敏度和准确度。
Objective To explore the value of combined detection of serum tumor markers in the diagnosis of lung cancer. Method Electrochemiluminescence immunoassay was used to detect the level of neuron specific enolase(NSE),carcinoembryonic antigen(CEA), squamous cell carcinoma antigen(SCCAg), carbohydrate antigen 125(CA125) and cyto-keratin 19 fragment antigen 21-1(CYFRA21-1) in the serum of 86 patients with lung cancer(lung cancer group), 92 patients with benign lung disease(benign lung disease group), and 96 healthy subjects(healthy control group). The serum tumor marker levels in the three groups were compared, besides, the tumor marker levels and positive rates among patients with different clinical types of lung cancer were comparatively evaluated, additionally, the tumor marker levels, the value of each tumor marker alone or in combination in the diagnosis of lung cancer in patients with varied clinical stage were compared. Result The levels of serum NSE, CEA, SCCAg, CA125, and CYFRA21-1 in lung cancer group were significantly higher than those in benign lung disease group and healthy control group(P<0.05); patients with small cell lung cancer had higher level and higher positive rate of NSE than those with adenocarcinoma and squamous cell carcinoma(P<0.05), the level of CEA and CA125 as well as the positive rates of ECA in adenocarcinoma were higher compared to squamous cell carcinoma and small cell carcinoma(P<0.05), while squamous cell carcinoma was associated with higher levels of SCCAg and CYFRA21-1 and positive rates of SCCAg, CYFRA21-1 and CA125 compared to adenocarcinoma and small cell carcinoma(P<0.05); NSE, CEA, SCCAg, CA125, and CYFRA21-1 levels were higher in patients with T3 stage disease than in those with T_1 stage disease(P<0.05), and the levels of NSE, CEA, CYFRA21-1 in patients with T_2 stage disease were significantly higher than that in those with T_1 stage disease(P<0.05); the sensitivity, negative predictive value and accuracy of combined detection comprising all the five tumor markers in the diagnosis of lung cancer was higher than that of each tumor marker alone, but the specificity and positive predictive value were lower instead, which were only 81.52% and 81.91%, respectively. Conclusion Great variances regarding the tumor marker levels are noted among lung cancer patients with different pathological types and clinical stage; the diagnostic value is limited when individual tumor marker is applied, and the combined detection may further improve the sensitivity, negative predictive value and accuracy for diagnosing lung cancer.
Objective To explore the value of combined detection of serum tumor markers in the diagnosis of lung cancer. Method Electrochemiluminescence immunoassay was used to detect the level of neuron specific enolase(NSE),carcinoembryonic antigen(CEA), squamous cell carcinoma antigen(SCCAg), carbohydrate antigen 125(CA125) and cyto-keratin 19 fragment antigen 21-1(CYFRA21-1) in the serum of 86 patients with lung cancer(lung cancer group), 92 patients with benign lung disease(benign lung disease group), and 96 healthy subjects(healthy control group). The serum tumor marker levels in the three groups were compared, besides, the tumor marker levels and positive rates among patients with different clinical types of lung cancer were comparatively evaluated, additionally, the tumor marker levels, the value of each tumor marker alone or in combination in the diagnosis of lung cancer in patients with varied clinical stage were compared. Result The levels of serum NSE, CEA, SCCAg, CA125, and CYFRA21-1 in lung cancer group were significantly higher than those in benign lung disease group and healthy control group(P<0.05); patients with small cell lung cancer had higher level and higher positive rate of NSE than those with adenocarcinoma and squamous cell carcinoma(P<0.05), the level of CEA and CA125 as well as the positive rates of ECA in adenocarcinoma were higher compared to squamous cell carcinoma and small cell carcinoma(P<0.05), while squamous cell carcinoma was associated with higher levels of SCCAg and CYFRA21-1 and positive rates of SCCAg, CYFRA21-1 and CA125 compared to adenocarcinoma and small cell carcinoma(P<0.05); NSE, CEA, SCCAg, CA125, and CYFRA21-1 levels were higher in patients with T3 stage disease than in those with T_1 stage disease(P<0.05), and the levels of NSE, CEA, CYFRA21-1 in patients with T_2 stage disease were significantly higher than that in those with T_1 stage disease(P<0.05); the sensitivity, negative predictive value and accuracy of combined detection comprising all the five tumor markers in the diagnosis of lung cancer was higher than that of each tumor marker alone, but the specificity and positive predictive value were lower instead, which were only 81.52% and 81.91%, respectively. Conclusion Great variances regarding the tumor marker levels are noted among lung cancer patients with different pathological types and clinical stage; the diagnostic value is limited when individual tumor marker is applied, and the combined detection may further improve the sensitivity, negative predictive value and accuracy for diagnosing lung cancer.
引文
[1]刘颖.肺癌CT影像学征象与EGFR基因突变相关性的研究进展[J].临床放射学杂志,2015,34(10):1695-1698.
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[11]南永刚,王晓敏,陆建荣,等.CA125在肿瘤患者细胞和血清中表达相关性的研究[J].现代肿瘤医学,2016,24(17):2798-2800.
[12]颜宇博,李丹.CA125单项与多项肿瘤指标联合检测在卵巢癌诊断中的比较[J].中国实用医药,2016,39(11):520-523.
[13]贾昂,肖建英,刘馨.血清肿瘤标志物CA199、CA125、CA242、CEA检测对不同分期胰腺癌相关性的分析[J].重庆医学,2011,40(35):3605-3607.
[14]赵雪莲,赵宏刚.血清CEA、NSE、CYFRA21-1在肺癌脑转移患者中的变化及其临床意义[J].卒中与神经疾病,2017,24(3):243-245.
[15]Cho A,Hur J,Hong YJ,et al.Prognostic impact of cytological fluid tumor markers in non-small cell lung cancer[J].Tumour Biol,2016,37(3):3205-3213.
[2]叶兵,邹莉莉,陆友国,等.血清肿瘤标志物联合检测在肺癌诊断中的临床价值[J].医学综述,2012,18(4):632-634.
[3]陆舜,纪文翔,虞永峰.2014版《NCCN非小细胞肺癌临床实践指南》更新解读[J].中国医师进修杂志,2015,38(5):318-320.
[4]曾聪,全国莉,王春莲.联合检测6种血清肿瘤标志物在肺癌诊断中的意义[J].广东医学,2012,33(6):808-810.
[5]李时孟,潘宝香,刘春迎,等.肿瘤标志物分子生物学检测技术研究的新进展[J].中国实验诊断学,2015,19(12):2148-2149.
[6]谢跃文,王强,夏洁.肿瘤标志物检测在恶性肿瘤诊断中的应用[J].国际检验医学杂志,2011,32(1):107-109.
[7]余建洪,朱晓丽.ROC曲线评价4项指标对肺癌的鉴别诊断价值[J].检验医学与临床,2017,14(3):361-363.
[8]徐巧玲,尤徐阳,吴娜静,等.临床病理学分析结合CEA、CA19-9与CA125检测对诊断胃癌术后腹膜转移的意义[J].标记免疫分析与临床,2016,23(11):1321-1326.
[9]张宝秋,丁湘彧,王雪玉,等.肿瘤标志物联合检测在肺癌诊断中的应用价值[J].国际检验医学杂志,2012,33(4):388-390.
[10]耿雪霏,邢汝东.CA125作为肿瘤标志物的研究进展[J].国际口腔医学杂志,2011,38(1):106-108.
[11]南永刚,王晓敏,陆建荣,等.CA125在肿瘤患者细胞和血清中表达相关性的研究[J].现代肿瘤医学,2016,24(17):2798-2800.
[12]颜宇博,李丹.CA125单项与多项肿瘤指标联合检测在卵巢癌诊断中的比较[J].中国实用医药,2016,39(11):520-523.
[13]贾昂,肖建英,刘馨.血清肿瘤标志物CA199、CA125、CA242、CEA检测对不同分期胰腺癌相关性的分析[J].重庆医学,2011,40(35):3605-3607.
[14]赵雪莲,赵宏刚.血清CEA、NSE、CYFRA21-1在肺癌脑转移患者中的变化及其临床意义[J].卒中与神经疾病,2017,24(3):243-245.
[15]Cho A,Hur J,Hong YJ,et al.Prognostic impact of cytological fluid tumor markers in non-small cell lung cancer[J].Tumour Biol,2016,37(3):3205-3213.