评价CYFRA21—1、NSE和CEA对非小细胞肺癌的诊断价值

目的评价血清CYFRA21—1、NSE和CEA对非小细胞肺癌（NSCLC）辅助诊断的价值。方法检测178例NSCLC患者，98例良性肺疾病（BED）患者和166例健康人血清中CYFRA21—1、NSE和CEA的浓度，CEA采用微粒子酶联免疫化学发光法，NSE和CYFRA21—1采用电化学发光法。结果三项血清肿瘤标志物（TM）在NSCLC中水平显著高于健康人和BLD患者。以健康人为对照组，特异性95％时，cutoff值分别为CYFRA21—12．23μg/L，CEA3．98μg／L，NSE20．39μg／L。对NSCLC诊断灵敏度分别为CYFRA21-1 63．5％，CEA47．8％，NSE29．2％；以良性肺疾病为对照组，特异性95％时，cutoff值分别为CYFEA21-1 3．26pg／L，CEA5．51μg／L，NSE26．14μg／L。对NSCLC灵敏度分别为CYFRA21—1 48．9％，CEA39．3％，NSE16．3％。CYFRA21—1对鳞癌的诊断灵敏度最高（66．2％），CEA对腺癌的诊断灵敏度最高（53．3％），NSE在非小细胞肺癌中也有一定的阳性率（13．0％-20．3％）。ROC曲线证实CYFRA21-1对良性肺疾病与非小细胞肺癌鉴别诊断价值最高。结论CYFRA21-1是诊断NSCIE尤其是鳞癌最有价值的TM，CEA对腺癌的诊断价值最高，CYFRA21—1和CEA联合显著提高NSCLC的诊断灵敏度。NSE对NSCLC的诊断价值较小。

Evaluating the diagnostic values of serum CYFRA21-1,NSE and CEA levels determination in patients with non-small lung cancer

Objective To evaluate the diagnostic values of serum CYFRA21-1, NSE and CEA levels determination in patients with non-small lung cancer （NSCLC） .Methods Serum concentrations of NSE,CEA and CYFRA21-1 were measured in 178 patients with NSCLC,98 patients with benign lung diseases （BID） and 166 healthy persons.CEA was measured by ebemiluminesent microparticle Immunoassay on ARCHITECT i2000sr. GYFRA21-1 and NSE were measured by electrocbemiluminescence immunoassays on the Roche Elecsys 2010. Results The serum concentrations of these three tumor markers were significandy higher in the NSCLC patients than in the healthy people and BLD patients When the healthy people were used as the reference group and the specificity was 95 %, the cutoff points of CYFRA 21-1 ,CEA and NSE were 2.23 μg/L,3.98μg/L and 20.39 μg/L respectively.At these points,the diagnostic sensitivities for NSCLC were CYFRA21-1 63.5% ,CEA 47.8% ,NSE 29.2% ,respectively.When the reference group was replaced with BLD patients,the cutoff points were elevated to 3.26μg/L,5.51 μg/L and 26.14μg/L respectively and the diagnostic sensitivities were reduced to 48.9 %, 16.3 % and 39.3 % respectively. For squamous cell carcinoma （SQC）, CYFRA21-1 was the most sensitive tumor marker （66.2%） and so was CEA for adenocarcinoma （53.3%）. The positive rates of NSE in the NSCLC ranged from 13.0% to 20.3% .Receiver operating curve demonstrated that CYFRA21-1 was the most valuable tumor marker for the differential diagnosis of BLD and NSCLC. Conclusion CYFRA 21-1 was of the most value for the diagnosis of NSCLC, especially squamous cell carcinoma. CEA was the most valuable tumor marker for adenocareinoma. There is little usefulness in diagnosing NSCLC for NSE.