肺癌患者血清肿瘤标志物联合检测及临床意义

目的探讨肿瘤标志物CEA、DR70、NSE和CYFRA21-1单项和联合检测对肺癌诊断的价值,评价血清中4项标志物水平在肺癌不同病理类型及治疗前后的表达意义。方法采用酶联免疫法检测130例肺癌患者和50例肺部良性疾病患者血清4项标志物水平,并以100名健康人为对照。同时对其中80例肺癌患者进行治疗前后标志物水平检测。结果肺癌患者CEA、DR70、NSE和CYFRA21-1血清水平高于肺良性疾病患者和健康人,差异有显著性意义(均P<0.01),肺部良性疾病患者和健康人比较差异无显著性;4项标志物在肺癌不同病理类型中CEA和NSE总体比较均有差异,其中腺癌CEA水平均高于其他类型(P<0.05￣0.01),小细胞肺癌NSE水平高于其他类型(均P<0.01);治疗有效的肺癌患者治疗后4项标志物水平均明显下降,而治疗无效者治疗前后均无明显变化。4项标志物联合检测的敏感度(73.1%)和准确度(80.5%)明显高于单项敏感度(分别为45.4%、24.6%、36.2%、33.8%)及准确度(分别为65.7%、55.2%、63.5%、60.7%)。结论CEA、DR70、NSE和CYFRA21-1联合检测可明显提高肺癌的阳性检出率;联合检测对鉴别肺癌与肺部良性疾病、肺癌不同病理类型,尤其对未能取得病理和细胞学证实的肺癌患者有一定的参考价值。同时检测治疗后标志物水平可以评估预后,观察治疗效果,为临床医师选择和改进治疗方案提供依据。

Detection and clinical significance of combined measurement of serum tumor markers in patients with lung cancer

Objective To study the clinical diagnosis value and the clinical significance of combined measurement of CEA, DR70, NSE and CYFRA21- 1 in patients with lung cancer. Methods The serum levels of CEA, DR70, NSE and CYFRA21- 1 were determined by ELISA in 130 patients with lung cancer, 50 patients with benign pulmonary disease and 100 cases of normal controls. Results The levels of serum CEA, DR70, NSE and CYFRA21- 1 in lung cancer patients were significantly higher than that in benign pulmonary disease patients and controls (P <0.01 respectively). The CEA level of adenocarcinoma was significantly higher than that of the other pathology types, and the NSE level of SCLC was significantly higher than that of the other pathology types. The 4 tumor markers levels of the patients of CR and PR after treatment were significantly lower than that before treatment. The sensitivity (73.1 %) of combined detection were significantly higher than that of the every single item(45.4 %, 24.6 %, 36.2 %, 33.8 % respectively),and the veracity (80.5 %) of combined detection were significantly higher than that of the every single item (65.7 %, 55.2 %, 63.5 %, 60.7 % respectively). Conclusions The results indicate that the combined use of CEA, DR70, NSE and CYFRA21- 1 can increase the diagnostic sensitivity of lung cancer. It is an useful adjunct measure for differentiation of the pathology types, and it is helpful in the evaluation of prognosis and clinical therapy effect.