摘要
目的评价血清细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)和癌胚抗原(CEA)在肺癌诊断中的价值,探讨3项肿瘤标志物血清水平与非小细胞肺癌(NSCLC)临床分期的关系。方法检测199例肺癌患者、98例良性肺疾病患者和116例健康人血清中CYFRA21-1、NSE和CEA的含量。CEA采用微粒子酶联免疫化学发光法检测,CYFRA21-1和NSE采用电化学发光法检测。结果 3项肿瘤标志物以良性肺疾病为对照,特异性为95%时,cut-off值分别为CYFRA21-13.26μg/L,CEA5.51μg/L,NSE26.14μg/L。以良性肺疾病组为对照,3项指标对肺癌的诊断灵敏度分别为CYFRA21-144.7%,NSE22.6%,CEA38.7%,如三者联合检测则诊断灵敏度显著提高至71.9%。CYFRA21-1对鳞癌的诊断灵敏度最高(66.2%),且在鳞癌各期都有较高灵敏度;CYFRA21-1对小细胞肺癌(SCLC)诊断灵敏度仅为9.5%。CEA对腺癌诊断灵敏度最高(53.3%),各期灵敏度分别为Ⅰ期23.1%,Ⅱ期36.4%,ⅢA期66.7%,ⅢB期64.3%,Ⅳ期74.9%。NSE对SCLC的诊断灵敏度最高(76.2%),而对NSCLC仅为16.3%。CY-FRA21-1和CEA分别与NSCLC的临床分期呈正相关。NSE血清水平在NSCLC各期无显著性差异。结论 CY-FRA21-1是诊断NSCLC和鳞癌最有价值的标志物,CEA对晚期腺癌的诊断价值较高,NSE对SCLC有最高的诊断价值,三者联合检测对肺癌诊断灵敏度显著提高。采用CYFRA21-1和NSE可对NSCLC和SCLC作鉴别诊断。CY-FRA21-1和CEA与NSCLC临床分期正相关,高浓度预示分期晚,低浓度则对分期参考作用小。
Objective To assess the applied value of serum CYFRA21-1,NSE and CEA in the diagnosis of lung cancer and discuss the relation of serum levels of the three tumor markers with the clinical stage of non-small cell lung cancer（NSCLC）.Methods The levels of CYFRA21-1,NSE and CEA in serum of 199 patients with lung cancer,98 patients with benign lung diseases and 116 healthy volunteers were determined.CEA levels were tested by using micro-particle enzyme chemiluminescence immunoassay,and those of CYFRA21-1 and NSE by using electrical chemiluminescence immunoassay.Results With the specificity of 95%,the cutoff values of CYFRA21-1,CEA and NSE were 3.26,5.51 and 26.14 μg/L respectively when benign lung diseases were used as controls.For lung cancer,the sensitivity of CYFRA21-1,NSE and CEA was 44.7%,22.6% and 38.7% respectively.The sensitivity was increased to 71.9% when three markers were used in combination.CYFRA21-1 was most sensitive to squamous cancer（66.2%）,while for small cell lung cancer（SCLC）,the sensitivity was only 9.5%.CEA was most sensitive to adenocarcinoma（53.3%）.The sensitivity at various stages were as follows：for stage Ⅰ,23.1%,for stage Ⅱ,36.4%,for stage ⅢA,66.7%,for stage ⅢB,64.3% and for stage Ⅳ,74.9%.NSE sensitivity to SCLC was 76.2% at maximum,while only 16.3% to NSCLC.CYFRA21-1 and CEA were positively related to the clinical stage of NSCLC respectively.There was no significant difference in NSE serum level among various stages of NSCLC.Conclusion CYFRA21-1 is the most valuable marker for the diagnosis of NSCLC and squamous cancer,CEA is highly valuable for the diagnosis of advanced adenocarcinoma,and NSE is the most valuable for the diagnosis of SCLC.Combination of the three markers greatly increases the diagnostic sensitivity to lung cancer.Differential diagnosis of NSCLC and SCLC can be made by using CYFRA21-1 and NSE.CYFRA21-1 and CEA are positively related to the clinical stage of NSCLC.High level predicts a late stage,while low level does not provide much information for determining the stage.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2010年第3期402-407,共6页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
