六种肿瘤标志物在肺癌诊断中的价值及其临床应用

目的:探讨单项检测及联合检测肿瘤标志物癌胚抗原(CEA)、糖类抗原(CA125)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、神经元特异性烯醇化酶(NSE)、胃泌素释放肽前体(Pro-GRP)、促血管生成素-2（Ang-2）在肺癌诊断、组织学分型、临床分期及检测复发中的应用价值。方法:分别对108例肺癌患者(肺癌组，诊断但尚未经治疗)、50例肺部良性病变患者(对照组)进行检测，对CEA、CA125、CYFRA21-1、NSE采用电化学发光法，对Pro-GRP、Ang-2采用酶联免疫法，并对检测结果进行分析。结果:肺癌组患者六种肿瘤标志物检测水平分别与对照组比较差异有统计学意义（P＜0.01）；肺癌Ⅳ期组各肿瘤标志物水平高于肺癌Ⅲ期组，肺癌Ⅲ期组各肿瘤标志物水平高于肺癌低分期(Ⅰ、Ⅱ期)组，比较差异均有统计学意义（P＜0.01）；复发组、淋巴结转移组中六种肿瘤标志物水平与无复发组、无淋巴结转移组比较差异有统计学意义（P＜0.01）；CEA、CA125分别对肺腺癌的阳性检出率与肺癌其他组织学分型比较差异有统计学意义（P＜0.01）；CYFRA21-1对肺鳞状细胞癌的阳性检出率与肺癌其他组织学分型比较差异有统计学意义（P＜0.01）；NSE、Pro-GRP分别对肺小细胞癌的阳性检出率与非小细胞肺癌比较差异有统计学意义(P＜0.01)；Ang-2对非小细胞肺癌的阳性检出率与小细胞肺癌比较差异有统计学意义(P＜0.01)；而腺癌和鳞癌中Ang-2的阳性检出率比较差异无统计学意义(P＞0.05)；Ang-2分别联合其他5项肿瘤标志物检测对肺癌组阳性检出率高于单项检测对肺癌组的阳性检出率；六种肿瘤标志物联合检测，阳性检出率明显提高。而六种肿瘤标志物联合检测的灵敏度、准确度和特异度均明显优于单个肿瘤标志物的检测，比较差异均有统计学意义(P＜0.01)。结论:CEA、CA125、CYFRA21-1、NSE、Pro-GRP和Ang-2对肺癌的诊断、组织学分型及临床分期有显著的意义，联合检测可显著提高肺癌患者的敏感度和准确度，并对临床分期和组织学分型及随访有重要价值，减少临床误诊、漏诊等情况的发生。

Six kinds of tumor markers in diagnosis of lung cancer and its clinical application value

Objective:To discuss single detection and combined detection of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA125),cytokeratin 19 fragment antigen 21-1 (CYFRA21-1),neuron specific enolase enzyme(NSE),gastrin-releasing peptide precursor(Pro-GRP),promote angiogenin-2(Ang-2) in lung cancer clinical application value of diagnosis.Methods:In 108 patients with lung cancer(lung cancer group),50 patients with lung benign lesions (control group) using the electrochemical luminescence method to detect the serum CEA,NSE,CA125,CYFRA21-1,using the enzyme-linked immunoassay method to detect Pro-GRP,Ang-2 levels.Results:Detection of six kinds of serum tumor markers in patients with lung cancer group level difference was statistically significant compared with controls,P＜0.01.Stage IV lung cancer group all tumor marker levels were higher than Ⅲ period lung cancer group,Ⅲ period lung cancer groups tumor markers level was higher than the lower lung cancer staging (group Ⅰ Ⅱperiod),P＜0.01.Recurrence and lymph node metastasis group of six kinds of tumor markers level compared with no recurrence and no lymph node metastasis group difference was statistically significant,P＜0.01.The positive rate of CEA,CA125 in lung adenocareinoma group,CYFRA21-1 in lung sqnamous cell carcinomas group and NSE and Pro-GRP in small cell lung carcinoma group were different from the other two kind of pathological types,P＜0.01.The positive rate of Ang-2 in non-small cell lung cancer group were difference from small cell lung cancer,P＜0.05;Ang-2 positive detection rate of squamous carcinoma and adenocarcinoma was not statistically significant different,P＞0.05.Ang-2 respectively combined five other tumor markers detection positive rate of lung cancer group was higher than single positive detection rate of lung cancer group.positive detection rate of the six kinds of tumor markers combined detection increased significantly.Sensitivity,accuracy and specific degrees of the 6 kinds of tumor markers combined detection were significantly better than that of single tumor markers,comparative differences are statistically significant,P＜0.01.Conclusion:NSE,CEA,CA125,CYFRA21-1,Pro-GRP and Ang-2 to the diagnosis of lung cancer,the type organization credits and clinical staging has significant significance.Joint detection can significantly improve the sensitivity and accuracy of the patients with lung cancer,for clinical staging and organization type of credits and follow-up have important value,Misdiagnosis and missed diagnosis were reduced.