联合检测血清CEA、CYFRA21-1、NSE在肺癌诊断、分期、分型中的意义

目的 探讨血清癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)在肺癌诊断、临床分期以及病理分型中的作用.方法 采用化学发光法、放射免疫分析法和酶联免疫吸附法分别检测114 例肺癌患者和89例肺部良性疾病患者血清CEA、CYFRA21-1、NSE水平.结果 肺癌组血清CEA、CYFRA21-1、NSE含量明显高于肺良性疾病组(P＜0.05);CEA、CYFRA21-1及NSE诊断肺癌的ROC曲线下面积分别是0.60、0.85、0.82;联合检测对肺癌诊断的灵敏度明显高于任何单一检测(P＜0.05);Ⅰ+Ⅱ期肺癌组血清CEA含量明显高于肺良性疾病组(P＜0.05);CEA 在腺癌组含量明显高于鳞癌组(P＜0.05);NSE在小细胞肺癌组含量明显高于鳞癌组和腺癌组(P＜0.05);血清CEA在Ⅰ、Ⅱ、Ⅲ期非小细胞肺癌组含量明显低于Ⅳ期(P＜0.05);CYFRA21-1在Ⅰ、Ⅱ期非小细胞肺癌组含量明显低于Ⅲ、Ⅳ期(P＜0.05).结论 CEA对肺癌的早期诊断有一定意义;血清CEA对腺癌的灵敏度最佳,NSE对小细胞肺癌的灵敏度最佳;早期肺癌血清CEA、CYFRA21-1水平明显低于晚期肺癌;三种肿瘤标志物联合检测可明显提高肺癌诊断的敏感性,对肺癌的临床诊断、病理分型、临床分期具有重要的临床意义.

Clinical Values of Combined Serum CEA,CYFRA21-1 and NSE Detection in Diagnosis,Staging and Predicting Pathologic Typing of Lung Cancer

Objective To evaluate the value of combined serum carcinoembryonic antigen（CEA）,cytokeratin fragment 19（CYFRA2I-1） and neuron-specific enolase（NSE） detection for diagnosis,staging and predicting of pathologic types in patients with pulmonary carcinoma.Methods The levels of CEA,CYFRA21-1 and NSE were measured in 114 patients with pulmonary carcinoma and 89 patients with pulmonary benign lesion,using chemoluminescence,RIA and ELISA methods respectively.Results The concentrations of CEA,CYFRA21-1 and NSE in the cancer patients group were obviously higher than those in benign lung diseases group（P 〈 0.05）. In single index the ROC area of serum CEA,CYFRA21-1 and NSE was 0.60,0.85,0.82.The sensitivity rate of combined detection achieved 91.20% and simultaneous detection can obviously improve the sensitivity for diagnosing of lung cancer comparing to single detection（P 〈 0.05）.The concentration of CEA in stage I and Ⅱ lung carcinoma group was obviously higher than that in benign lung diseases group（P 〈 0.05）.CEA was significantly increased in lung adenocarcinoma and NSE was increased in small cell lung carcinoma（P 〈 0.05）. For non-small cell lung carcinomas,CEA concentration in I. Ⅱ .Ⅲ stages was obviously lower than Ⅳ stage（P 〈 0.05）,CYFRA21-1 showed no significant changes in I and Ⅱ stages,but obviously lower than Ⅲ and Ⅳ stages（P 〈 0.05）.Conclusions CEA have a certain value for the diagnosis of the prophase pulmonary carcinoma,and its concentration was significantly lower than the advanced stages.The combined detection of the three tumor markers would to some extend be useful in of pathologic types in lung carcinomas. improving sensitivity of diagnosis,staging and predicting of pathologic types in lung carcinomas.