血清CA125和神经元特异性烯醇化酶在矽肺患者中的改变及临床意义

摘要

目的：探讨CA125和神经元特异性烯醇化酶( NSE)在矽肺患者血清中的改变。方法随机选取2010年4月至2014年4月于我院就诊并被确诊为矽肺的男性患者66例,另纳入同期于我院体检的健康男性40例。研究对象分为矽肺组66例、健康人组40例。采用电化学发光法检测所有研究对象血清癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原(CA19-9)和NSE水平。结果矽肺组血清CA125和NSE水平显著高于健康人组(PCA125=0．043,PNSE =0．025)。血清 CA125和 FGF18水平之间呈显著正相关(r =0．601,P =0．003)。血清CA125和NSE水平在Ⅰ期、Ⅱ期和Ⅲ期矽肺患者中差异有统计学意义,在Ⅱ期患者中高于Ⅰ期患者(PCA125<0．001,PNSE =0．001),在Ⅲ期患者中高于Ⅱ期患者(PCA125<0．001,PNSE <0．001)。 Pearson相关分析显示,矽肺患者血清CA125水平与FEV1呈负相关(r=-0．11,P=0．04)；血清NSE水平与FVC、FEV1、FEV1/FVC之间呈负相关(r=-0．28,PFVC =0．02；r=-0．51,PFEV1=0．042；r=-0．36,PFEV1/FVC =0．019),与CA125呈正相关(r=0．509,PCA125=0．007)。 NSE的诊断曲线下面积(0．804,P<0．01)优于CA125(0．773,P<0．01)。当NSE的诊断阈值为12．9 ng/mL时,其诊断的敏感性为71%,特异性为84%,两者联合诊断的ROC曲线下面积为0．838(P<0．01)。结论血清NSE和CA125对矽肺患者诊断的灵敏性和特异性均较好,尤其是两者联合诊断可能成为矽肺的血清学辅助诊断指标。%Objective To investigate the serum expression of CA125 and neuron-specific enolase (NSE) in silicosis patients. Methods Sixty-six silicosis cases and 40 healthy cases were selected randomly from April 2010 to April 2014 in our hospital in this study. Serum levels of CEA,CA125,CA19-9 and NSE were detected by electrochemi-cal luminescence method. Results The levels of CA125 and NSE in silicosis were significantly higher than those of healthy controls (PCA125 =0. 043,PNSE =0. 025). Serum levels of CA125 and NSE in stageⅡpatients were significant-ly higher than that of stageⅠ patients (PCA125 <0. 001,PNSE =0. 001),while serum levels of CA125 and NSE in stageⅢ patients were higher than that of stage Ⅱ patients (PCA125 <0. 001,PNSE <0. 001). CA125 showed negative correla-tion with FEV1 (r= -0. 11,P=0. 04) by Pearson analysis. While NSE showed negative correlation with FVC,FEV1, FEV1/FVC(r= -0. 28,PFVC =0. 02;r= -0. 51,PFEV1 =0. 042;r= -0. 36,PFEV1/FVC =0. 019),positive correlation with CA125(r=0. 509,PCA125 =0. 007). Receiver operating characteristic (ROC) curves were used to evaluate the diagnosis value of CA125 and NSE. The area under curve ( AUC) of CA125 and NSE were 0. 773 and 0. 804 respectively. The AUC of combined diagnosis was 0. 838. When the cut-off was 12. 9 ng/mL,the sensitivity and specificity of NSE were 71% and 84% respectively. Conclusion The serum levels of CA125 and NSE might be an useful diagnostic biomark-er. The combined diagnosis can increase the sensitivity and specificity in diagnosis of silicosis.