肺癌患者血清肿瘤标记物检测的临床意义及预后评估

目的评估血清癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)和特异性烯醇化酶(NSE)水平在肺癌诊断中的价值,探讨三项肿瘤标记物血清水平与患者临床特征、化疗疗效和预后的关系。方法采用化学发光法检测227例肺癌患者和60例肺良性疾病患者血清中CEA、CYFRA21-1、NSE含量,同时收集患者完整的临床资料,随访患者无进展生存时间(PFS),使用SPSS17.0软件对所得数据进行统计分析。结果 1肺癌组血清CEA、CYFRA21-1、NSE水平明显高于肺良性疾病组(P0.01);CEA、CYFRA21-1、NSE的ROC曲线下面积分别是0.8、0.6、0.8,均大于0.5。腺癌、鳞癌、小细胞肺癌分别以CEA、CYFRA21-1、NSE检测灵敏度最高(P0.01)。三项肿瘤标记物联合检测较单项检测诊断灵敏度显著提高。2与I+II期患者比较,IV期肺癌患者CEA、CYFRA21-1、NSE水平明显升高(P0.05);胸外转移组三项肿瘤标记物均显著高于无转移组(P0.05)。3疾病进展(PD)组患者的治疗前血清CYFRA21-1、NSE水平明显高于疾病控制(DC)组(P0.05)。4治疗前血清CYFRA21-1、NSE水平正常的患者PFS明显长于升高者(P0.05)。结论血清CEA、CYFRA21-1和NSE检测有助于肺癌的诊断,联合检测更优,且对鉴别肺癌与肺部良性疾病、有无转移的评价及肺癌不同病理类型和分期有一定的参考价值;同时,治疗前CYFRA21-1和NSE血清水平可以评估肺癌的预后,观察治疗效果。

Clinical significance and prognostic evaluation of serum tumor markers in patients with lung cancer

Objective To assess the diagnostic value of serum carcinoembryonic antigen （ CEA） , cytokera-tin 19 fragment （CYFRA21-1） and neuron specific enolase （NSE） in patients with lung cancer, and to investigate the relationship between the levels of three tumor markers and clinical characteristics, chemotherapeutic response, prognosis in patients with lung cancer. Methods The levels of serum CEA, CYFRA21-1and NSE were detected by Chemiluminescence （ CLIA） in 227 patients with lung cancer and 60 patients with benign pulmonary disease. At the same time, the clinical materials of the two groups were collected completely. PFS was taken from patients followed up until the disease progression. Statistical analysis was performed by using SPSS 17. 0 software. Results ① The levels of serum CEA, CYFRA21-1 and NSE in the lung cancer group were significantly higher than those in the be-nign pulmonary disease group （P〈0. 01）. ROC curves showed that the under-curve area of CEA, CYFRA21-1 and NSE was 0. 8, 0. 6 and 0. 8 respectively, each of which was more than 0. 5. The highest sensitivity of serum tumor markers in adencarcinoma, squamous cell carcinoma and small cell lung cancer was CEA, CYFRA21-1 and NSE re-spectively. Compared with each single item, the diagnostic sensitivity of the combined detection of the three tumor markers was greatly improved. ②The levels of CEA, CYFRA21-1 and NSE in patients at stageⅣwere significantly higher than those in patients at stagesⅠandⅡ（P〈0. 05）. The levels of the three tumor markers were all higher in patients with distant metastasis than those in patients without metastasis. ③ Before the treatment, the levels of CY-FRA21-1 and NSE in the PD group were significant higher than those in the DC group （ P〈0. 05 ） . ④ The PFS of the patients with normal serum CYFRA21-1 and NSE before the treatment was longer than that of the patients with el-evated CYFRA21-1 and NSE （5. 16 ± 2. 56 vs 3. 03 ± 1. 41, 5. 12 ± 1. 54 vs 3. 90 ± 1. 86;P〈0. 05）. Concl