五种血清肿瘤标志物检测对非小细胞肺癌术后复发诊断研究

目的 探讨非小细胞肺癌（NSCLC）术后复发的血清学及影像学检查指标的诊断价值.方法 收集34例NSCLC术后患者为研究对象,应用固体蛋白质芯片（C-12）对患者血清肿瘤标志物CEA,Cyfra21-1,NSE,CA125和CA15-3等指标进行持续检测,观察在术后1月及初次发现肺内或肺外复发病灶时点及确诊时的各个血清肿瘤标志物的表达水平变化;观察单一肿瘤标志物表达水平与胸部CT等影像学表现的相关性;使用串联试验方法检验多肿瘤标志物联合检测对术后复发的早期诊断有效性.结果 在影像学检查发现可疑病灶但尚不能确诊时,有7例（20.59％）患者肿瘤标志物检测异常,能够进行临床诊断复发的病例数占全部患者的14.71％.在影像学初次发现可疑病灶时,CEA最为敏感,且组间比较差异有统计学意义（t=0.001,P＜0.01）.在基线时点组和最终确诊肿瘤复发的两个组内,NSE,Cyfra21-1及CA15-3检测值差异有统计学意义（P＜0.05）;而CA125在组间表达差异无统计学意义（t=0.083,P＞0.05）.根据随访结果最终确定复发的标志物诊断效价评估中,CEA的正确诊断指数最高,YI=0.683,与病灶的恶性相关;其次是Cyfra21-1,YI=0.628.结论 血清肿瘤标志物结合影像学检查可有效发现NSCLC术后复发,检测到CEA等标志物的持续升高具有更大临床价值.该方法可为临床判断肺癌术后复发提供快捷、简便、有效的诊断方法.

Application of Tumor Markers for Early Diagnosis in the Postoperative Recidivation of NSCLC

Objective To explore the role of tumor markers for early diagnosis in the postoperative recidivation of NSCLC.Methods 34 cases of NSCLC patients after surgery accepted ongoing follow-up examination of serum tumor markers inclouding CEA,Cyfra21-1,NSE,CA125,CA15-3,chest CT and other imaging.Observed the correlation of expression level of the tumor markers and the imaging findings.Results Comparing with the value of the CEA,NSE,Cyfra21-1 and CA15-3 when the suspicious tumor lesion was found in the imaging first,those values were significantly higher when the postoperative recidivation was diagnosed in the imaging finally.But,the value of the CA125 had no statistical difference between two groups.CEA had the highest index of correct diagnosis of 0.683,and the next was Cyfra21-1 of 0.628.Before the suspicious tumor lesion was found in the imaging,the value of CEA or CA153 was found higher than that in normal in 4 cases of 34 patients,and CEA and CA153 were higher simultaneously in 1 patient.When the suspicious tumor lesion was found in the imaging first,the value of tumor makers showed higher than that in normal in 7 cases （20.59 ％）,and 14.71 ％ of patients could be diagnosed of postoperative recidivation finally.Conclusion The postoperative recidivation can be found earlier by imaging examination combined with tumor makers,and ongoing follow-up examination of CEA has very important clinical value.The continuous monitoring of tumor makers may be the early and noninvasive method for monitoring of recidivation of NSCLC.