胸水CA125、CA199、CEA、NSE、CYFRA21-1、CA72-4对原发性肺癌的诊断价值

目的探讨胸水中糖链抗原125（CA125）、糖链抗原199（CA199）、癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21—1）和糖链抗原72-4（CA72-4）在原发性肺癌并胸腔积液的诊断和鉴别诊断、病理分型中的价值。方法采用电化学免疫荧光发光法同时检测90例原发性肺癌并胸腔积液患者（恶性胸腔积液组）和64例良性胸腔积液患者（良性胸腔积液组）胸水中CA125、CA199、CEA、NSE、CYFRA21-1和CA72-4水平。结果恶性胸腔积液组各胸水肿瘤标志物水平均高于良性胸腔积液组（P〈0．05），其中CEA、CYFRA21-1、NSE分别对腺癌、鳞癌、小细胞肺癌最敏感。联合检测以CEA＋NSE＋CYFRA21-1最优，可使敏感性达98．9％，阴性预测值至96．6％，准确性提高至76．0％。结论胸水肿瘤标志物在原发性肺癌的诊断中价值较高，其中CEA的诊断价值最大，联合检测诊断准确性优于单项检测。

Clinical Value of Detection of CA125, CA199, CEA,NSE, CYFRA21-1 and CA72-4 in Pleural Effusion in Primary Lung Cancer

Objective To assess the diagnostic and differentially diagnosing values of carbohydrate antigen-125 （ CA-125 ）, carbohydrate antigen-199 （ CA-199 ）, carcinoembryonic antigen （ CEA ）, neuron-specific enolase （ NSE）, cytokeratin 19 fragments （ CYFRA21-1 ）, carbohydrate antigen-724 （ CA-724 ） of pleural effusion in primary lung cancer. Methods Electrochemical immune luminescence process was used to determine the level of CA125, CA199, CEA, NSE, CYFRA21-1, CA724 in pleural effusion among 90 cases of primary lung cancer with madignant pleural effusion and 64 cases of benign pleural effusion. Results Pleural effusion levels of the 6 tumor marker in the malignant pleural effusion group were significantly higher than the levels in the benign pleural effusion group（P 〈 0.05）, CEA was sensitive to lung adenocarcinoma, CYFR21-1 was sensitive to lung squamous cell carcinoma and NSE was sensitive to small cell lung carcinoma. For the combination of 3 tumor markers ,CEA ＋ NSE ＋ CYFRA21-1 showed 98.9% sensitivity,96.6% negative predictive value and 76.0% accuracy for lung cancer. Conclusion In the diagnosis and differential diagnosis of primary lung cancer, these 6 tumor markers in the pleural effusion show certain important values, CEA was the important marker, and combination of them was better than any single marker.