血清IGF-1及CEA、CYFRA21-1、NSE联合检测在肺癌诊治中的价值

摘要

目的 研究血清胰岛素样生长因子(IGF-1)及CEA、细胞角质素片断抗原(CYFRA21-1)、神经元特异性烯醇化酶(NSE)联合检测在肺癌诊治中的临床价值,以筛选理想的血清肿瘤标志物组合.方法 应用放射免疫分析法检测30名健康人、91例肺癌患者和15例肺部良性疾病患者血清IGF-1,同时应用电化学发光免疫分析法测定同一批研究对象的血清CEA、CYFRA21-1、NSE水平,采用Kruskal-Wallis单因素方差分析Mann-Whitney秩和检验进行统计学比较.用ROC曲线对各项指标的诊断效能进行分析和评价,曲线下面积(AUC)采用Wilcoxon检验分析.结果 肺癌患者的血清IGF-1水平及3种血清肿瘤标志物水平均明显高于健康人组和肺部良性疾病组,差异有统计学意义(IGF-1:χ2=26.95,P<0.001;CEA:χ2=49.11,P<0.001;CYFRA21-1:χ2=40.63,P<0.001;NSE:χ2=14.76,P<0.001),治疗后肺癌患者的IGF-1及CYFRA21-1水平比未治疗患者的IGF-1水平低,差异有统计学意义(IGF-1:χ2=5.99,P=0.014;CYFRA21-1:χ2=4.99,P=0.025).IGF-1、CEA、CYFRA21-1和NSE在特异性为95.6%(43/45)时,灵敏度分别为75.6%(34/45)、53.3%(24/45)、66.7%(30/45)和42.2%(19/45),以IGF-1最高;各指标的ROC AUC分别为0.880、0.836、0.891和0.697,以IGF-1与CYFRA21-1较高;联合检测以IGF-1+CYFRA21-1与IGF-1+CEA+CYFRA21-1较好,灵敏度分别达到95.6%(43/45)和97.8%(44/45),AUC分别为0.969和0.984.结论 血清中IGF-1、CEA、CYFRA21-1和NSE对肺癌的诊断均有一定的临床价值.IGF-1可判断疗效并进行随访.IGF-1与CEA、CYFRA21-1、NSE联合检测可显著提高肺癌诊断的灵敏度和效能,IGF-1+CYFRA21-1与IGF-1+CEA+CYFRA21-1是诊断肺癌较为理想的组合.%Objective To evaluate four tumor markers of insulin-like growth factor 1((IGF-1), CEA, cytokeratin fragment antigen 21-1 (CYFRA21-1), neuron-specific enolase (NSE) for the diagnosis and prediction of treatment response in human lung cancer. Methods Serum samples were taken from three groups: 91 patients with lung cancer, 30 healthy adults and 15 patients with benign pulmonary diseases. Serum IGF-1 was assayed by radioimmunoassay and CEA, CYFRA21-1, and NSE by electrochemiluminescence immunoassay. The differences among the three groups were determined by Kruskal-Wallis one-way analysis of variance (ANOVA) and with Mann-Whitney rank-sum test. Diagnostic efficacy was evaluated by ROC curves. Results The four serum tumor marker levels were significantly higher in lung cancer group, as compared with the benign and the healthy (IGF-1:χ2=26.95,P<0.001, CEA:χ2=49.11,P<0.001; CYFRA21-1:χ2=40.63,P<0.001; NSE:χ2=14.76;P<0.001). The diagnostic sensitivities of IGF-1, CEA, CYFRA21-1 and NSE was 75.6% (34/45), 53.3% (24/45), 66.7% (30/45) and 42.2% (19/45) respectively for lung cancer. The diagnostic sensitivity of IGF-1 combined with CYFRA21-1 was 95.5 %( 43/45) and that of IGF-1 combined with CEA and CYFRA21-1was 97.8%(44/45). Only IGF-1 and CYFRA21-1 showed significant changes before and after treatment (IGF-1: χ2=5.99,P=0.014; CYFRA21-1:χ2=4.99, P=0.025) in cancer group. Conclusions Serum IGF-1, CEA, CYFRA21-1 and NSE are all valuable for lung cancer diagnosis and the combination of those parameters can enhance the diagnostic efficiency. Serum IGF-1 and CYFRA21-1 may also be useful for evaluating the treatment response in lung cancer.