血清NSE、CYFRA21-1、CEA和CA50联检诊断肺癌及其与肺癌病理分型的关系

目的：分析肺癌及肺部良性疾病患者血清CEA、NSE、CYFRA21-1的水平变化及其与肺癌病理组织类型的关系,探讨其在肺癌诊断中的价值。方法：检测89例初治肺癌和37例良性肺病患者血清NSE、CYFRA21-1、CEA和CA50的水平。NSE采用免疫放射分析（IRMA）,CYFRA21-1和CA50采用放射免疫分析（RIA）,CEA采用化学发光免疫分析。结果：肺癌组各肿瘤标志物血清水平皆显著高于肺部良性疾病组（P〈0.05）;NSE＋CYFRA21-1＋CEA联检对肺癌诊断的灵敏度、特异性和准确性分别为87.6%、86.5%和87.3%,灵敏度和准确性明显大于各标志物单项检测（P〈0.05）;肺癌肿瘤标志物血清水平和灵敏度与病理类型有关,灵敏度：血清CEA以腺癌最高（73.9%）,血清NSE以小细胞肺癌（SCLC）最高（75.0%）,血清CYFRA21-1以鳞癌最高（80.6%）,血清CA50对各病理类型肺癌皆不高（20.5%～39.5%）。结论：NSE、CYFRA21-1、CEA肿瘤标志物检测有利于指导肺癌的病理分型,联检明显提高了对肺癌诊断的灵敏度。

Diagnostic Value of Gombined Determination of Serum Tumor Markers (NSE, CYFRA21-1, CEA and CA50) Levels in Patients with Lung Cancer

Objective To study the diagnostic value of determination of serum levels of NSE,CYFRA21-1,CEA and CA50 in patients with lung cancer.Methods Serum NSE（with IRMA）,CYFRA21-1,CA50（with RIA）and CEA（with CLIA）levels were measured singly or combinedly in 89 patients with lung cancer and 37 patients with various kinds of benign lung disorders.Results The levels of serum NSE,CYFRA21-1,CEA and CA50 in patients with lung cancer were all significantly higher than the respective levels in patients with benign lung diseases（P〈0.05）.The sensitivity,and accuracy of combined determination of NSE,CYFRA21-1 and CEA was 87.6% and 87.3%,respectively,being higher（P〈0.05）than that with any single determination.The specificity of combined determination（86.5%）was lower than that of CYFRA21-1（91.9%）.For various pathologic types of lung cancer,the diagnostic sensitivity with different markers varied greutly CEA determination was most sensitive for adenocarcinoma（73.9%）,NSE was most sensitive for small cell lung carcinoma（75.0%）.CYFRA21-1 was most sensitive with squamous cell carcinoma（80.6%）.However,sensitivity of CA50 determination was poor for all kinds of lung cancer（20.5~39.5% only）.Conclusion Determination of for serum levels of NSE,CYFRA21-1 and CEA is helpful clinical diagnosis of lung cancer,and combined determination can increase the sensitivity very much.