血清肿瘤标记物联合动态检测在肺癌早期诊断和监控治疗中的临床价值

摘要

目的：探讨血清肿瘤标记物糖类抗原CA50、癌胚抗原CEA、鳞状上皮癌抗原Scc- Ag、细胞角蛋白19片段抗原21-1（CYFRA21-1）、人多效蛋白PTN、神经元特异性烯醇化酶NSE联合动态检测在肺癌早期诊断和监控治疗中的临床应用价值。方法：采用电化学发光法和酶联免疫法分别检测201例肺癌患者（肺癌组）、50例肺部良性病变患者（良性对照组）及50例健康体检者（正常对照组）血清肿瘤标记物CA50、CEA、Scc- Ag、CYFRA21-1、PTN、NSE水平，采用回顾性统计方法分析血清肿瘤标记物与肺部良恶性疾患的相关性，探讨其联合动态检测在肺癌早期诊断和监控治疗中的临床价值。结果：（1）肺癌患者血清CA50、CEA、Scc- Ag、CYFRA21-1、PTN、NSE水平明显高于肺部良性病变组及正常对照组（＜0.01）；（2）肺癌患者血清CA50、CEA、Scc- Ag、CYFRA21-1、PTN、NSE水平与患者性别、年龄、肿瘤发生部位无明显相关性（均＞0.05），与肿瘤大小、临床分期、组织学类型、复发转移、伴胸腔积液及治疗后明显相关（均＜0.01）；（3） CA50、CEA分别在肺腺癌患者血清表达水平及阳性检出率较高，Scc- Ag、CYFRA21-1分别在肺鳞癌患者血清表达水平及阳性检出率较高，PTN、NSE分别在肺小细胞癌患者血清表达水平及阳性检出率较高（均＜0.01）；（4） CA50、CEA、Scc- Ag、CYFRA21-1、PTN、NSE诊断肺癌的敏感性分别为46.27%（93/201）、49.75%（100/201）、50.75%（102/201）、44.28%（89/201）、50.25%（101/201）、48.76%（98/201），准确性分别为55.38%（139/251）、57.77%（145/251）、59.36%（149/251）、53.39%（134/251）、58.57%（147/251）、56.97%（143/251），六项肿瘤标记物联合检测诊断肺癌特异性虽有所降低86%（43/50），但敏感性、准确性明显提高，分别为95.02%（191/201）、93.23%（234/251），与各单项检测比较差异有统计学意义（均＜0.01）。结论：血清肿瘤标记物CA50、CEA、Scc- Ag、CYFRA21-1、PTN、NSE联合动态检测可作为肺癌早期诊断的辅助手段及疾病复发转移和治疗有效性的监控指标，有利于临床早期诊断、指导治疗、判断预后。%Objective: To investigate the clinical application value of serum tumor marker carbohydrate antigen CA50, carci-noembryonic antigen (CEA), squamous cell carcinoma antigen (Scc- Ag), antigen of cytokeratin 19 fragment (CYFRA21- 1), people multi- effect PTN protein and neuron specific enolization enzyme NSE joint dynamic testing in the early diagnosis and monitoring of lung cancer. Methods: Serum tumor marker levels of CA50、 CEA、 Scc- Ag、 CYFRA21- 1、 PTN、 NSE were measured with electrochemiluminescence and ELISA respectively in 201 patients with lung cancer and 50 patients with lung benign lesions and 50 cases of healthy physical examination. Retrospective statistical methods were used to analyze the correlation of the serum tumor mark-ers and benign and malignant lung disease, and futher to explore the early diagnosis and monitoring clinical value in lung cancer by serum tumor markers joint dynamic detection treatment. Results:(1)Serum CA50, CEA, Scc- Ag, CYFRA21- 1, PTN, NSE levels in lung cancer group were significantly higher than the group of lung benign disease and normal control ( <0.01) ; (2) The levels of serum CA50, CEA, Scc- Ag, CYFRA21- 1, PTN, NSE in lung cancer patients had no significant correlation with patients' gender, age, tumor location( >0.05), but all were significantly related with tumor size, clinical stage, histological type, recurrence and metasasis, combining pleural effusion and post treatment(all <0.01); (3)Serum CA50 and CEA had higher expression levels and positive detec-tion rate in lung adenocarcinoma patients; Scc- Ag and CYFRA21- 1 had higher serum expression levels and positive detection rate in lung squamous carcinoma patients; PTN and NSE had higher serum expression levels and positive detection rate in small cell lung cancer patients (all <0.01) ; (4) The sensitivity of CA50, CEA, Scc Ag, CYFRA21- 1, PTN, NSE in the diagnosis of lung cancer was 46.27%(93/201), 49.75%(100/201), 50.75%(102/201), 44.28% (89/201) and 50.25%(101/201), 48.76%(98/201) respectively, ac-curacy was 55.38% (139/251), 57.77% (145/251), 59.36%(149/251),53.39%(134/251),58.57%(147/251) and 56.97%(143/251)respec-tively. The specificity 86% (43/50) of six tumor markers joint detection for lung cancer was reduced, but the sensitivity 95.02%(191/201) and accuracy 93.23% (234/251) significantly increased, which had statistical significance compared with the single ex-amination ( <0.01). Conclusion: Serum tumor markers CA50, CEA, Scc- Ag, CYFRA21- 1, PTN, NSE in combination with the dynamic testing can be used as a means for early diagnosis of lung cancer and monitoring indicators for recurrence and metastasis and effectiveness,which are beneficial to the clinical early diagnosis and directed therapy and prognosis judgement.