血清肿瘤标志物联合检测在肺癌诊断中的应用

    Diagnostic value of serum tumor markers in lung cancer

    • 摘要: 目的:探讨糖类抗原125(CA125)、糖类抗原242(CA242)、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)等5项肿瘤标志物联合检测对肺癌的诊断价值。方法:采用流式荧光发光法,对肺癌组80例和肺良性疾病组46例的血清CA-125、CA242、CEA、CYFRA21-1和NSE等5项肿瘤标志物进行检测。结果:CA125、CA242、CEA、CYFRA21-1和NSE在肺癌组中的表达均显著高于肺良性疾病组(P<0.01)。CEA在肺腺癌中的水平较高,CA125、CA242在鳞癌和小细胞肺癌中的水平较高。单项肿瘤标志物在肺癌诊断中灵敏度:CYFRA21-1>CEA>CA125>NSE>CA242;在腺癌中CYFRA21-1灵敏度最高(50.00%),鳞癌中CYFRA21-1灵敏度最高(48.94%),小细胞肺癌中CA125和NSE灵敏度最高(48.15%)。CA125、CA242、CEA、CYFRA21-1和NSE的ROC曲线下面积分别为0.669±0.095、0.608±0.097、0.682±0.096、0.714±0.090、0.660±0.096。在肺癌诊断中CA125+CA242+CEA+CYFRA21-1+ NSE组合灵敏度最高(70.00%),特异性也较好(84.78%);腺癌诊断中联合检测灵敏度与单项CYFRA21-1检测灵敏度相同(50.00%),但联合检测的约登指数大于单项CYFRA21-1;鳞癌诊断中CA125+CA242+CEA+CYFRA21-1组合灵敏度最高(72.34%),小细胞肺癌中CA125+CA242+CEA+CYFRA21-1+NSE组合灵敏度最高(88.89%)。结论:CA125、CA242、CEA、CYFRA21-1和NSE对肺癌的诊断均有一定意义,但单一指标诊断的灵敏度和特异性都有一定局限,联合检测可有效提高肺癌诊断的灵敏度和特异性。

       

      Abstract: Objective: To explore the diagnostic value of the combined detection of serum cancer antigen 125(CA125),carbohydrate antigen 242(CA242),carcinoembryonic antigen(CEA),cytokeratin 19 fragments(CYFRA21-1) and neuron specific enolase(NSE),tumor marker,in lung cancer.Methods: The biomarker levels of CA-125,CA242,CEA,CYFRA21-1 and NSE in 80 patients with lung cancer and 46 patients with benign lung disease were measured by the immunoluminometric assay.Results: The levels of CA-125,CA242,CEA,CYFRA21-1 and NSE in the patients with lung cancer were significantly higher than those in the patients with benign lung disease(P<0.01).The high levels of CEA,CA125 and CA242 in the patients with lung adenocarcinoma,squamous carcinoma and small cell lung cancer were found,respectively.The sensitivity of CYFRA21-1 in lung cancer was the highest,followed by CEA,CA125,NSE and CA242.The highest sensitivities of CYFRA21-1 in adenocarcinoma and squamous cell carcinoma were 50.00% and 48.94%,respectively.The sensitivities of CA125 and NSE in small cell lung cancer were the highest(48.15%).The areas under the ROC curve of CA125,CA242,CEA,CYFRA21-1 and NSE were 0.669±0.095,0.608±0.097,0.682±0.096,0.714±0.090 and 0.660±0.096,respectively.The sensitivity and specificity of the combined detection of CA125,CA242+CEA,CYFRA21-1 and NSE in the diagnosis of lung cancer were high and good(70.00% and 84.78%),respectively.The specificities of the CYFRA21-1 and CYFRA21-1 combined with other factors in the diagnosis of adenocarcinoma were the same(50.00%),but the Youden index of the latter was more than the former.The sensitivities of the combined detections of CA125,CA242,CEA and CYFRA21-1 in diagnosing squamous cell carcinoma and CA125,CA242+CEA,CYFRA21-1 and NSE in diagnosing small cell lung cancer were the highest,which were 72.34% and 88.89%,respectively.Conclusions: The single detection of CA125,CA242,CEA,CYFRA21-1 and NSE has certain significance in the diagnosis of lung cancer,but the sensitivity and specificity of which are limited.The combined detection of multi-markers can improve the sensitivity and specificity in diagnosing the lung cancer.

       

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