血清肿瘤标志物在肺结核初治患者中的临床意义

目的探讨血清肿瘤标志物水平在肺结核初治患者中的临床意义。方法收集2017年1月—2018年6月60例肺结核初治患者为肺结核组,60例肺细胞腺癌患者为肺癌组,120例健康体检者为正常对照组,采用化学发光免疫技术测定血清CA125、CA19-9、CA153、CEA、SCC水平,比较肺结核组、肺癌组、正常对照组的血清肿瘤标志物水平及肺结核组患者治疗前后血清肿瘤标志物水平变化。结果肺结核组患者治疗前血清CA125、CA19-9、CA153、CEA和SCC水平分别为(24.51±12.84) U/mL、(15.21±5.59) U/mL、(12.98±5.78) U/mL、(3.49±0.57) ng/mL和(1.43±0.56) ng/mL,肺癌组为(30.75±12.73) U/mL、(26.40±8.43) U/mL、(30.68±14.66) U/mL、(3.50±0.29) ng/mL和(1.01±0.08) ng/mL,正常对照组为(12.29±3.74) U/mL、(11.73±5.93) U/mL、(9.26±4.26) U/mL、(1.37±0.36) ng/mL和(0.98±0.18) ng/mL,肺结核组和正常对照组的血清CA125、CA19-9和CA153水平均低于肺癌组患者,差异有统计学意义(P<0.05)。肺结核组患者血清CA125、CA19-9、CA153、CEA和SCC水平均高于正常对照组,差异均具有统计学意义(P<0.05)。肺结核组患者治疗后为(15.15±8.47) U/mL、(18.13±9.04) U/mL、(14.57±7.26) U/mL、(3.26±1.64) ng/mL和(1.25±0.33) ng/mL,肺结核患者治疗前后,CA125水平差异具有统计学意义(P<0.05)。Logistic回归分析发现,CA125和CA19-9作为主效应被纳入模型中,利用预测值绘制ROC曲线AUC为0.903(95%CI:0.813~0.993),敏感性、特异性和理想界值点分别为0.892、1.000和0.30,提高了诊断效能。结论联合检测血清CA125和CA19-9水平,并利用其建立联合诊断模型,可较好地鉴别肺结核和肺细胞腺癌。同时,血清CA125水平可作为肺结核患者病情进展和评估治疗效果的标志物。

Clinical significance of serum tumor marker levels in pulmonary tuberculosis patients receiving an initial treatment

Objective To explore the clinical significance of serum tumor marker levels in pulmonary tuberculosis patients receiving an initial treatment. Methods The clinical data of 60 patients with initial treated pulmonary tuberculosis from Jan. 2017 to June 2018, and 60 patients with lung adenocarcinoma were collected, 120 healthy persons were chosen as the control group. The serum CA125, CA19-9, CA153, CEA and SCC levels of patients with pulmonary tuberculosis, healthy individuals and patients with lung adenocarcinoma were detected by electrochemical fluorescence immunoassay. The serum tumor marker levels of patients with pulmonary tuberculosis were detected and compared before and after treatment. Results The serum CA125, CA19-9, CA153, CEA and SCC levels of patients with pulmonary tuberculosis were (24.51±12.84) U/mL, (15.21±5.59) U/mL, (12.98±5.78) U/mL, (3.49±0.57) ng/mL and (1.43±0.56) ng/mL, while the concentration levels were (15.15±8.47) U/mL, (18.13±9.04) U/mL, (14.57±7.26) U/mL, (3.26±1.64) ng/mL and (1.25±0.33) ng/mL after standardized treatment. Then lung adenocarcinoma patients were (30.75±12.73) U/mL, (26.40±8.43) U/mL, (30.68±14.66) U/mL, (3.50±0.29) ng/mL and (1.01±0.08) ng/ml, while healthy individuals were (12.29±3.74) U/mL, (11.73±5.93) U/mL, (9.26±4.26) U/mL, (1.37±0.36) ng/mL and (0.98±0.18) ng/mL. The serum CA125, CA19-9 and CA153 levels of patients with pulmonary tuberculosis and healthy individuals were all significantly lower than patients with lung adenocarcinoma. The serum CA125, CA19-9, CA153, CEA and SCC levels of patients with pulmonary tuberculosis were higher than healthy individuals (P<0.05). The serum CA125 levels in initial treatment patients with pulmonary tuberculosis declined from （24.51±12.84）U/mL before treatment to (15.15±8.47) U/mL after standardized treatment (P<0.05). Logistic regression analysis showed that CA125 and CA19-9 were introduced to model as the main effect. The ROC analysis revealed that AUC was 0.93 (95%CI: 0.813-0.993). The sensitivity, specificity in serum and ideal boundary point were 0.892, 1.000 and 0.30 respectively ,with an improved diagnostic efficiency. Conclusions A combined detection of serum CA125 and CA19-9 and the combined diagnostic model can identify pulmonary tuberculosis and lung adenocarcinoma. At the same time, the serum CA125 level can be used as a bio-marker for assessing the progression and treatment effectiveness of patients with pulmonary tuberculosis.