4项肿瘤标志物在肺癌诊断中的应用价值

目的探讨肿瘤标志物胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19的可溶性片段(CYFRA21-1)和鳞状细胞癌抗原(SCC)在肺癌诊断中的临床价值。方法选择151例肺癌及肺部良性病变患者为研究对象,其中小细胞肺癌(SCLC)43例,非小细胞肺癌(NSCLC)68例(包括腺癌35例、鳞癌33例),肺部良性病变患者40例,另选取健康体检者40例纳入健康对照组。采用罗氏电化学发光仪E601检测所有研究对象血清中的ProGRP、NSE、CYFRA21-1和SCC水平。结果 SCLC组的ProGRP和NSE水平均明显高于NSCLC-腺癌组、NSCLC-鳞癌组及肺部良性病变组,而NSCLC-腺癌组和NSCLC-鳞癌组的CYFRA21-1和SCC水平均明显高于SCLC组及肺部良性病变组,差异均有统计学意义(P<0.05)。在单项指标中,ProGRP在SCLC中的灵敏度和特异度最高,分别为77.2%和91.1%;CYFRA21-1在NSCLC-腺癌和NSCLC-鳞癌中的灵敏度和特异度较高,分别为65.9%和90.1%,以及71.5%和91.2%;在联合检测中,ProGRP+NSE在SCLC中的灵敏度和特异度分别为92.5%和83.6%;CYFRA21-1+SCC对NSCLC-腺癌和NSCLC-鳞癌的灵敏度在83.0%以上,特异度在85.0%以上。结论 ProGRP与NSE联合检测诊断SCLC的价值优于单项肿瘤标志物的检测;CYFRA21-1与SCC联合检测对NSCLC-腺癌和NSCLC-鳞癌有较高的灵敏度和特异度,这些肿瘤标志物诊断和筛查肺癌的潜力值得进一步研究。

Clinic value of four tumor markers in patients with lung cancer

Objective To exploer the clinical value of progastrin-releasing peptide(ProGRP),neuron specific enolase(NSE),cytokeratin-19 fragment(CYFRA21-1),squamous cell carcinoma antigen(SCC)in the diagnosis for lung cancer.Methods Peripheral blood were obtained from 151 patients with lung cancer or benign lung lesions,including 43 patients with small cell lung cancer(SCLC),68 patients with non-small cell lung cancer(NSCLC including 35 patients with lung adenocarcinoma and 33 patients with lung squamous cell carcinoma),40 patients with benign lung diseases.A total of 40 healthy subjects were included in the control group.The serum levels of ProGRP,NSE,CYFRA21-1 and SCC were measured with a commercially available electrochemiluminiscent assay(Elecsys,Roche Diagnostics,Germany).Results The levels of ProGRP and NSE in SCLC were apparently higher than lung adenocarcinoma,lung squamous cell carcinoma and benign lung diseases,while the levels of CYFRA21-1 and SCC in lung adenocarcinoma and lung squamous cell carcinoma were apparently higher than those of SCLC and benign lung disease,the differences were statistically significant(P<0.05).The highest sensitivity and specificity of ProGRP for diagnosing SCLC were 77.2%and91.1%separately.The sensitivity and specificity of CYFRA21-1 for diagnosing lung adenocarcinoma and lung squamous cell carcinoma were 65.9%and 90.1%,71.5%and 91.2%respectively.The sensitivity and specificity of combined ProGRP and NSE for diagnosing SCLC were 92.5% and 83.6% separately.The sensitivity and specificity of combined CYFRA21-1 and SCC for diagnosing lung adenocarcinoma and lung squamous cell carcinoma were more than 83.0% and 85.0% respectively.Conclusion The combined assessment of a panel of ProGRP and NSE is a more accurate marker for SCLC presence than these same tumor markers considered individually.There are higher sensitivity and specificity of combined CYFRA21-1 and SCC for diagnosing lung adenocarcinoma and lung squamous cell carcinoma.The potential of these tumor markers in the diagnostic and screening settings deserve further research.