血清肿瘤标志物在肺结核初治患者中的临床意义
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摘要
目的探讨血清肿瘤标志物水平在肺结核初治患者中的临床意义。方法收集2017年1月—2018年6月60例肺结核初治患者为肺结核组,60例肺细胞腺癌患者为肺癌组,120例健康体检者为正常对照组,采用化学发光免疫技术测定血清CA125、CA19-9、CA153、CEA、SCC水平,比较肺结核组、肺癌组、正常对照组的血清肿瘤标志物水平及肺结核组患者治疗前后血清肿瘤标志物水平变化。结果肺结核组患者治疗前血清CA125、CA19-9、CA153、CEA和SCC水平分别为(24.51±12.84)U/mL、(15.21±5.59)U/mL、(12.98±5.78)U/mL、(3.49±0.57)ng/mL和(1.43±0.56)ng/mL,肺癌组为(30.75±12.73)U/mL、(26.40±8.43)U/mL、(30.68±14.66)U/mL、(3.50±0.29)ng/mL和(1.01±0.08)ng/mL,正常对照组为(12.29±3.74)U/mL、(11.73±5.93)U/mL、(9.26±4.26)U/mL、(1.37±0.36)ng/mL和(0.98±0.18)ng/mL,肺结核组和正常对照组的血清CA125、CA19-9和CA153水平均低于肺癌组患者,差异有统计学意义(P<0.05)。肺结核组患者血清CA125、CA19-9、CA153、CEA和SCC水平均高于正常对照组,差异均具有统计学意义(P<0.05)。肺结核组患者治疗后为(15.15±8.47)U/mL、(18.13±9.04)U/mL、(14.57±7.26)U/mL、(3.26±1.64)ng/mL和(1.25±0.33)ng/mL,肺结核患者治疗前后,CA125水平差异具有统计学意义(P<0.05)。Logistic回归分析发现,CA125和CA19-9作为主效应被纳入模型中,利用预测值绘制ROC曲线AUC为0.903(95%CI:0.813～0.993),敏感性、特异性和理想界值点分别为0.892、1.000和0.30,提高了诊断效能。结论联合检测血清CA125和CA19-9水平,并利用其建立联合诊断模型,可较好地鉴别肺结核和肺细胞腺癌。同时,血清CA125水平可作为肺结核患者病情进展和评估治疗效果的标志物。
Objective To explore the clinical significance of serum tumor marker levels in pulmonary tuberculosis patients receiving an initial treatment. Methods The clinical data of 60 patients with initial treated pulmonary tuberculosis from Jan. 2017 to June 2018, and 60 patients with lung adenocarcinoma were collected, 120 healthy persons were chosen as the control group. The serum CA125, CA19-9, CA153, CEA and SCC levels of patients with pulmonary tuberculosis, healthy individuals and patients with lung adenocarcinoma were detected by electrochemical fluorescence immunoassay. The serum tumor marker levels of patients with pulmonary tuberculosis were detected and compared before and after treatment. Results The serum CA125, CA19-9, CA153, CEA and SCC levels of patients with pulmonary tuberculosis were(24.51±12.84) U/mL,(15.21±5.59) U/mL,(12.98±5.78) U/mL,(3.49±0.57) ng/mL and(1.43±0.56) ng/mL, while the concentration levels were(15.15±8.47) U/mL,(18.13±9.04) U/mL,(14.57±7.26) U/mL,(3.26±1.64) ng/mL and(1.25±0.33) ng/mL after standardized treatment.Then lung adenocarcinoma patients were(30.75±12.73) U/mL,(26.40±8.43) U/mL,(30.68±14.66) U/mL,(3.50±0.29) ng/mL and(1.01±0.08) ng/ml, while healthy individuals were(12.29±3.74) U/mL,(11.73±5.93) U/mL,(9.26±4.26) U/mL,(1.37±0.36)ng/mL and(0.98±0.18) ng/mL. The serum CA125, CA19-9 and CA153 levels of patients with pulmonary tuberculosis and healthy individuals were all significantly lower than patients with lung adenocarcinoma. The serum CA125, CA19-9, CA153,CEA and SCC levels of patients with pulmonary tuberculosis were higher than healthy individuals(P<0.05). The serum CA125 levels in initial treatment patients with pulmonary tuberculosis declined from(24.51±12.84)U/mL before treatment to(15.15±8.47) U/mL after standardized treatment(P<0.05). Logistic regression analysis showed that CA125 and CA19-9 were introduced to model as the main effect. The ROC analysis revealed that AUC was 0.93(95%CI: 0.813-0.993). The sensitivity,specificity in serum and ideal boundary point were 0.892, 1.000 and 0.30 respectively,with an improved diagnostic efficiency.Conclusions A combined detection of serum CA125 and CA19-9 and the combined diagnostic model can identify pulmonary tuberculosis and lung adenocarcinoma. At the same time, the serum CA125 level can be used as a bio-marker for assessing the progression and treatment effectiveness of patients with pulmonary tuberculosis.
Objective To explore the clinical significance of serum tumor marker levels in pulmonary tuberculosis patients receiving an initial treatment. Methods The clinical data of 60 patients with initial treated pulmonary tuberculosis from Jan. 2017 to June 2018, and 60 patients with lung adenocarcinoma were collected, 120 healthy persons were chosen as the control group. The serum CA125, CA19-9, CA153, CEA and SCC levels of patients with pulmonary tuberculosis, healthy individuals and patients with lung adenocarcinoma were detected by electrochemical fluorescence immunoassay. The serum tumor marker levels of patients with pulmonary tuberculosis were detected and compared before and after treatment. Results The serum CA125, CA19-9, CA153, CEA and SCC levels of patients with pulmonary tuberculosis were(24.51±12.84) U/mL,(15.21±5.59) U/mL,(12.98±5.78) U/mL,(3.49±0.57) ng/mL and(1.43±0.56) ng/mL, while the concentration levels were(15.15±8.47) U/mL,(18.13±9.04) U/mL,(14.57±7.26) U/mL,(3.26±1.64) ng/mL and(1.25±0.33) ng/mL after standardized treatment.Then lung adenocarcinoma patients were(30.75±12.73) U/mL,(26.40±8.43) U/mL,(30.68±14.66) U/mL,(3.50±0.29) ng/mL and(1.01±0.08) ng/ml, while healthy individuals were(12.29±3.74) U/mL,(11.73±5.93) U/mL,(9.26±4.26) U/mL,(1.37±0.36)ng/mL and(0.98±0.18) ng/mL. The serum CA125, CA19-9 and CA153 levels of patients with pulmonary tuberculosis and healthy individuals were all significantly lower than patients with lung adenocarcinoma. The serum CA125, CA19-9, CA153,CEA and SCC levels of patients with pulmonary tuberculosis were higher than healthy individuals(P<0.05). The serum CA125 levels in initial treatment patients with pulmonary tuberculosis declined from(24.51±12.84)U/mL before treatment to(15.15±8.47) U/mL after standardized treatment(P<0.05). Logistic regression analysis showed that CA125 and CA19-9 were introduced to model as the main effect. The ROC analysis revealed that AUC was 0.93(95%CI: 0.813-0.993). The sensitivity,specificity in serum and ideal boundary point were 0.892, 1.000 and 0.30 respectively,with an improved diagnostic efficiency.Conclusions A combined detection of serum CA125 and CA19-9 and the combined diagnostic model can identify pulmonary tuberculosis and lung adenocarcinoma. At the same time, the serum CA125 level can be used as a bio-marker for assessing the progression and treatment effectiveness of patients with pulmonary tuberculosis.
引文
[1]WHO(2017).Global Tuberculosis Report 2017[R/OL].(2018-01-01)[2018-12-19].http://www.who.int/tb/publications/global_report/en/.
[2]LI Y,EHIRI J,TANG S L,et al.Factors associated with patient,and diagnostic delays in Chinese TB patients:A systematic review and meta-analysis[J].BMC Med,2013,11:156.
[3]CHANDRA T,SELVARAJ R,SHARMA Y.Same day sputum smear microscopy for the diagnosis of pulmonary tuberculosis:Ziehl-Neelsen versus fluorescent staining[J].J Family Med Prim Care,2015,4(4):525-528.
[4]FARAZI A,MOHARAMKHANI A,SOFIAN M.Validity of serum adenosine deaminase in diagnosis of tuberculosis[J].Pan Afr Med J,2013,15:133-138.
[5]AFRASIABIAN S,MOHSENPOUR B,BAGHERI K H,et al.Diagnostic value of serum adenosine deaminase level in pulmonary tuberculosis[J].J Res Med Sci,2013,18(3):252-254.
[6]HALDAR S,SANKHYAN N,SHARMA N,et al.Detection of Mycobacterium tuberculosis GlcB or HspX Antigens or devR DNA impacts the rapid diagnosis of tuberculous meningitis in children[J].PLoS One,2012,7(9):e44630.
[7]PAN S J,TAPLEY A,ADAMSON J,et al.Biomarkers for tuberculosis based on secreted,species-specific,bacterial small molecules[J].J Infect Dis,2015,212(11):1827-1834.
[8]王静,刘立宾,岳永宁,等.TB-SAT检测支气管肺泡灌洗液诊断肺结核的价值研究[J].预防医学,2018,30(4):429-431.
[9]WANG Z,TIAN Y P.Clinical value of serum tumor markers CA19-9,CA125 and CA72-4 in the diagnosis of pancreatic carcinoma[J].Molecular and Clinical Oncology,2014,2(2):265-268.
[10]HE C Z,ZHANG K H,LI Q,et al.Combined use of AFP,CEA,CA125 and CAl9-9improves the sensitivity for the diagnosis of gastric cancer[J].BMC Gastroenterol,2013,13:87.
[11]O'RIORDAN D K,DEERY A,DORMAN A,et al.Increased CA125 in a patient with tuberculous peritonitis:Case report and review of published works[J].Gut,1995,36(2):303-305.
[12]SULAIMAN S,TAN K H.Markedly-elevated serum CA125 in a woman with pulmonary tuberculosis[J].Singapore Med J,2009,50(1):39-40.
[13]SEKIYA K,SAKAI T,HOMMA S,et al.Pulmonary tuberculosis accompanied by a transient increase in serum carcinoembryonic antigen level with tuberculous empyema drainage[J].Intern Med,2007,46(21):1795-1798.
[14]RACIL H,SAAD S,ROUHOU S C,et al.The value of tumor markers in pulmonary tuberculosis[J].Tunis Med,2009,87(5):330-333.
[15]KIM E S,PARK K U,SONG J,et al.The clinical significance of CA-125 in pulmonary tuberculosis[J].Tuberculosis(Edinb),2013,93(2):222-226.
[16]MA J J,XIA D,HU J,et al.Predicive role of serem tumor markers in diagnosis of pulmonary tuberculosis[J].Iran J Public Health,2016,45(4):435-440.
[17]梁曼曼,杨江华.血清CA 125与CA 199水平变化在继发性肺结核初治患者中的临床意义[J].现代预防医学,2014,41(10):1832-1834.
[18]任健.肺结核患者血清肿瘤标志物水平的变化及其临床意义[J].实验与检验医学,2016,34(6):734-736.
[19]ALI N,NATH N,PARVIN R,et al.Role of ascitic fluid adenosine deaminase(ADA)and serum CA-125 in the diagnosis of tuberculous peritonitis[J].Bangladesh Med Res Counc Bull,2015,40(3):89-91.
[20]NOUWEN E J,POLLET D E,EERDEKENS M W,et al.Immunohistochemical localization of placental alkaline phosphatase,carcinoembryonic antigen,and cancer antigen 125 in normal and neoplastic human lung[J].Cancer Res,1986,46(2):866-876.
[21]李珍,韩其政.CA125在呼吸系统疾病中的应用[J].医学综述,2012,18(13):2022-2024.
[22]许海,刘莹.血清CA199、CA125及AFP联合检测在宫颈肿瘤诊断中的应用研究[J].热带医学杂志,2015,15(6):766-769.
[23]RONAY G,J?GER W,TULUSAN A H.Immunohistochemical and serologic detection of Ca-125 in patients with peritoneal tuberculosis and ascites[J].Geburtshilfe Frauenheilkd,1989,49(1):61-63.
[24]ISHIURA Y,FUJIMURA M,MINAMI S,et al.Increased CA19-9level in serum and bronchoalveolar lavage fluid from a patient with pulmonary tuberculosis[J].Nihon Kyobu Shikkan Gakkai Zasshi,1996,34(4):477-481.
[25]KOMIYA T,MATSUSHIMA T,KIMURA M,et al.A case of endobronchial tuberculosis with high serum CA19-9 and SLX level[J].Kekkaku,1994,69(10):615-619.
[26]董庆梅.CA125、CA153、CA199、CEA联合检测对肺癌与肺结核的鉴别诊断价值及疗效评估价值[J].医药论坛杂志,2014,35(7):13-15.
[27]HONG J Y,JANG S H,KIM S Y,et al.Elevated serum CA 19-9 levels in patients with pulmonary nontuberculous mycobacterial disease[J].The Brazilian Journal of Infectious Diseases,2016,20(1):26-32.2018-12-19
[2]LI Y,EHIRI J,TANG S L,et al.Factors associated with patient,and diagnostic delays in Chinese TB patients:A systematic review and meta-analysis[J].BMC Med,2013,11:156.
[3]CHANDRA T,SELVARAJ R,SHARMA Y.Same day sputum smear microscopy for the diagnosis of pulmonary tuberculosis:Ziehl-Neelsen versus fluorescent staining[J].J Family Med Prim Care,2015,4(4):525-528.
[4]FARAZI A,MOHARAMKHANI A,SOFIAN M.Validity of serum adenosine deaminase in diagnosis of tuberculosis[J].Pan Afr Med J,2013,15:133-138.
[5]AFRASIABIAN S,MOHSENPOUR B,BAGHERI K H,et al.Diagnostic value of serum adenosine deaminase level in pulmonary tuberculosis[J].J Res Med Sci,2013,18(3):252-254.
[6]HALDAR S,SANKHYAN N,SHARMA N,et al.Detection of Mycobacterium tuberculosis GlcB or HspX Antigens or devR DNA impacts the rapid diagnosis of tuberculous meningitis in children[J].PLoS One,2012,7(9):e44630.
[7]PAN S J,TAPLEY A,ADAMSON J,et al.Biomarkers for tuberculosis based on secreted,species-specific,bacterial small molecules[J].J Infect Dis,2015,212(11):1827-1834.
[8]王静,刘立宾,岳永宁,等.TB-SAT检测支气管肺泡灌洗液诊断肺结核的价值研究[J].预防医学,2018,30(4):429-431.
[9]WANG Z,TIAN Y P.Clinical value of serum tumor markers CA19-9,CA125 and CA72-4 in the diagnosis of pancreatic carcinoma[J].Molecular and Clinical Oncology,2014,2(2):265-268.
[10]HE C Z,ZHANG K H,LI Q,et al.Combined use of AFP,CEA,CA125 and CAl9-9improves the sensitivity for the diagnosis of gastric cancer[J].BMC Gastroenterol,2013,13:87.
[11]O'RIORDAN D K,DEERY A,DORMAN A,et al.Increased CA125 in a patient with tuberculous peritonitis:Case report and review of published works[J].Gut,1995,36(2):303-305.
[12]SULAIMAN S,TAN K H.Markedly-elevated serum CA125 in a woman with pulmonary tuberculosis[J].Singapore Med J,2009,50(1):39-40.
[13]SEKIYA K,SAKAI T,HOMMA S,et al.Pulmonary tuberculosis accompanied by a transient increase in serum carcinoembryonic antigen level with tuberculous empyema drainage[J].Intern Med,2007,46(21):1795-1798.
[14]RACIL H,SAAD S,ROUHOU S C,et al.The value of tumor markers in pulmonary tuberculosis[J].Tunis Med,2009,87(5):330-333.
[15]KIM E S,PARK K U,SONG J,et al.The clinical significance of CA-125 in pulmonary tuberculosis[J].Tuberculosis(Edinb),2013,93(2):222-226.
[16]MA J J,XIA D,HU J,et al.Predicive role of serem tumor markers in diagnosis of pulmonary tuberculosis[J].Iran J Public Health,2016,45(4):435-440.
[17]梁曼曼,杨江华.血清CA 125与CA 199水平变化在继发性肺结核初治患者中的临床意义[J].现代预防医学,2014,41(10):1832-1834.
[18]任健.肺结核患者血清肿瘤标志物水平的变化及其临床意义[J].实验与检验医学,2016,34(6):734-736.
[19]ALI N,NATH N,PARVIN R,et al.Role of ascitic fluid adenosine deaminase(ADA)and serum CA-125 in the diagnosis of tuberculous peritonitis[J].Bangladesh Med Res Counc Bull,2015,40(3):89-91.
[20]NOUWEN E J,POLLET D E,EERDEKENS M W,et al.Immunohistochemical localization of placental alkaline phosphatase,carcinoembryonic antigen,and cancer antigen 125 in normal and neoplastic human lung[J].Cancer Res,1986,46(2):866-876.
[21]李珍,韩其政.CA125在呼吸系统疾病中的应用[J].医学综述,2012,18(13):2022-2024.
[22]许海,刘莹.血清CA199、CA125及AFP联合检测在宫颈肿瘤诊断中的应用研究[J].热带医学杂志,2015,15(6):766-769.
[23]RONAY G,J?GER W,TULUSAN A H.Immunohistochemical and serologic detection of Ca-125 in patients with peritoneal tuberculosis and ascites[J].Geburtshilfe Frauenheilkd,1989,49(1):61-63.
[24]ISHIURA Y,FUJIMURA M,MINAMI S,et al.Increased CA19-9level in serum and bronchoalveolar lavage fluid from a patient with pulmonary tuberculosis[J].Nihon Kyobu Shikkan Gakkai Zasshi,1996,34(4):477-481.
[25]KOMIYA T,MATSUSHIMA T,KIMURA M,et al.A case of endobronchial tuberculosis with high serum CA19-9 and SLX level[J].Kekkaku,1994,69(10):615-619.
[26]董庆梅.CA125、CA153、CA199、CEA联合检测对肺癌与肺结核的鉴别诊断价值及疗效评估价值[J].医药论坛杂志,2014,35(7):13-15.
[27]HONG J Y,JANG S H,KIM S Y,et al.Elevated serum CA 19-9 levels in patients with pulmonary nontuberculous mycobacterial disease[J].The Brazilian Journal of Infectious Diseases,2016,20(1):26-32.2018-12-19