血清肿瘤标志物联合检测在肺癌诊断中的应用

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。

Diagnostic value of serum tumor markers in lung cancer

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 d