肺癌患者血清肿瘤标志物检测的临床意义

目的探讨肺癌患者血清肿瘤标志物癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21—1）、神经元特异性烯醇化酶（NSE）的水平及化疗治疗前后的变化。方法用放射免疫分析的方法分别测定20例肺部良性疾病、20例小细胞肺癌（SCLC）以及45例初诊晚期非小细胞肺癌（NSCLC）患者化疗前后血清CEA、CYFRA21．1、NSE的水平，再分别作对比分析。结果肺癌组CEA、CYFRA21．1、NSE水平高于良性疾病组，但CYFRA21．1在良性疾病和小细胞肺癌中、NSE在良性疾病和鳞癌以及良性疾病和腺癌中差异均无统计学意义（均P〉0．05）；化疗后小细胞肺癌患者NSE显著下降[（55．22±17．48）M／L与（17．92±3．98）μg／L，t=6．07，P〈0．01]，鳞癌患者CYFRA21．1水平显著下降（P〈0．01），但在腺癌患者只有NSE水平较化疗前下降（P〈0．05）。结论三种肿瘤标志物在非小细胞肺癌晚期均升高，其中CEA在腺癌、CYFRA21—1在鳞癌、NSE在SCLC中尤为明显，化疗后显著下降，以作为判定不同病理类型肺癌化疗疗效的指标。

Clinical significance of serum tumor markers in patients with lung cancer

Objective To investigate the serum tumor markers level of carcinoembryonic antigen(CEA) ,cytokeratin fragment antigen21-1 (CYFRA21-1),neuron specific enolase (NSE) in patients with lung cancer, and the change after chemotherapy on them. Methods Radioimmunoassay was applied to detect the levels of CEA, CYFRA21-1 ,NSE in 45 patients with advanced NSCLC before and after chemotherapy,and the tumor markers were also detected in 20 patients with SCLC and 20 patients with benign lung diseases of control groups. Results The levels of CEA, CYFRA21-1, NSE in lung cancer group before chemotherapy were much higher than benign group, but there was no difference of CYFRA21-1 between the SCLC group and benign group. The same result of NSE was found between NSCLC and benign group(P ＞0. 05). The value of NSE was lower in the patients with SCLC after chemotherapy than before(P ＜0. 01 ). The level of CYFRA21-1 was lower in squamous carcinoma than before( P ＜0. 01 ). But in the adenocarcinoma group only NSE's level was lower after chemotherapy( P ＞0. 05) ,there were no differences in CEA and CYFRA21-1 ( P ＞ 0. 05 ). Conclusion The levels of the three tumor markers rise obviously in advanced NSCLC and decrease after chemotherapy. The differences were significant with NSE in SCLC and CYFRA21-1 in squamous cell carcinoma and CEA in adenocarcinoma. The levels of serum CEA,CYFRA21-1 and NSE could be a tumor marker in progressive lung cancer. And the decrease of the levels could be used to evaluate the chemotherapeutic response respectively in different pathologic types of lung cancer.