血清肿瘤标记物CYFRA21-1、CEA和NSE联合检测在肺癌诊断的应用

目的 探讨三项血清肿瘤标记物CYFRA21-1、CEA 和NSE联合检测对肺癌的诊断价值及与肿瘤病理类型的相关性.方法 采用化学发光技术测定经病理确诊的187例肺癌患者、33例肺良性疾病和30名健康对照的血清中CYFRA21-1、CEA 和NSE水平,应用SPSS18统计软件包进行统计学分析.结果 187例肺癌患者血清中NSE、CEA、CYFRA21-1的水平显著高于肺良性疾病组和正常对照组,三组间行方差分析有显著差别,但肺良性病与健康对照组比无显著差别;三项血清肿瘤标记物在鳞癌、腺癌和小细胞肺癌中的水平有显著差别,CYFRA21-1、CEA 和NSE分别在肺鳞癌、肺腺癌和小细胞肺癌中的水平较高.单项肿瘤标志物在肺癌诊断中敏感性：NSE〉CYFRA21-1〉CEA;在腺癌中CEA敏感性最高（43.1%）,鳞癌中CYFRA21-1敏感性最高（60.0%）,小细胞肺癌中NSE敏感性最高（83.8%）;NSE、CYFRA21-1、CEA的ROC曲线下面积分别为0.845±0.027、0.782±0.031、0.657±0.036,NSE显示诊断准确性较高.在肺癌诊断中NSE、CEA、CYFRA21-1组合敏感性最高（77.5%）,特异性也较好（76.2%）.结论 NSE、CEA、CYFRA21-1对肺癌的诊断均有一定意义,不同病理类型各有特点,选择合适的组合有利于对肺癌的鉴别诊断.

Application of Combined Detection of CYFRA21-1, NSE and CEA in Diagnosis of Lung Cancer

Objective To investigate the diagnostic value of serum CYFRA21-1,CEA and NSE for lung cancer and their correlation with tumor pathologic types. Methods The levels of serum CYTRA21-1,CEA and NSE were detected by electrochemoluminescence immunoassay in 187 lung cancer patients,33 patients with benign lung diseases and 30 healthy people,SPSS18 software package was used for statistical analysis. Results The levels of serum CYFRA21-1,CEA and NSE in 187 patients with lung cancer were obviously higher than those in patients with benign lung diseases and in normal controls,with significant difference in variance analysis among the groups,while no difference between benign lung disease and control groups.The levels of serum CYFRA21- 1,CEA and NSE showed significantly difference in squamous cell carcinoma, adenocarcinoma and small lung cell cancer.The levels of CYFRA21-1,CEA and NSE were higher in squamous cell carcinoma, adenocarcinoma and small lung cell cancer, respectively.The sequence of sensitivity of single tumor marker in diagnosis of lung cancer：NSE〉CYFRA21-1 〉CEA.CEA showed the highest sensitivity of about 43.1% in adenocarcinoma. CYFRA21-1 showed the highest sensitivity of about 60.0% in squamous cell carcinoma.NSE showed the highest sensitivity of about 83.8% in small cell lung cancer.ROC curves showed that the under-curve area of NSE,CYFRA21-1 and CEA was 0.845 ±0.027,0.782 ±0.031,0.657 ±0.036, respectively.NSE presented higher diagnostic accuracy.The combination of NSE,CEA and CYFRA21-1 showed the highest sensitivity（77.5%） and better specificity（76.2%） for diagnosis of lung cancer. Conclusion The assay of NSE,CEA and CYFRA21-1 had significance for diagnosis of lung cancer and showed respective characteristics among different pathologic types. The suitable combination of tumor markers are helpful for differential diagnosis of lung cancer.