联合检测血清肿瘤标志物在肺癌诊断中的价值  

Clinical Value of Combined Detection of Serum Tumor Markers in Lung Cancer Diagnosis

作　　者：陈锋[1] 李为民[1] 王冬梅[1] 高蜀生[2] 包勇[2] 陈文彬[1] 刘丹[1] 

机构地区：[1]四川大学华西医院呼吸内科,成都610041 [2]成都市第三人民医院呼吸内科

出　　处：《四川大学学报（医学版）》2008年第5期832-835,共4页Journal of Sichuan University(Medical Sciences)

基　　金：成都市“十一五”科技规划重大专项(批准号07YTYB961-020)资助

摘　　要：目的探讨血清多种肿瘤标志物联合检测在肺癌诊断中的价值。方法采用放射免疫法、化学发光法、酶联免疫吸附法和生化发光法对340例肺癌患者以及120例肺部良性病变患者进行癌胚抗原(CEA)、糖类癌抗原125(CA125)、糖类癌抗原199(CA199)、细胞角蛋白片段19(CYFRA21-1)和神经原特异性烯醇化酶(NSE)水平的检测,并计算上述指标在肺癌诊断中的敏感度、特异度和准确度。结果单项检测各种肿瘤标志物诊断肺癌的敏感度和准确度以CYFRA21-1最高(60.0%和70.3%),特异度以CA199最高(99.4%)。联合检测较单项检测敏感度明显增高,两项检测以CA125和CA199特异度最高(94.5%),敏感度和准确度以CYFRA21-1和NSE联合最高(82.9%和83.4%)。3项检测以CEA、CA125和CA199特异度最高(86.7%),敏感度和准确度以CEA、NSE和CYFRA21-1联合最高(89.1%和85.1%),CEA、CA125、CA199、CYFRA21-1和NSE5项联合效果最佳,其敏感度高达93.8%,特异度71.5%,准确度86.5%。结论多项血清肿瘤指标联合检测较单项检测明显增高诊断肺癌的敏感度和准确度。Objective To investigate the clinical significance of a combination of several serum tumor markers in the diagnosis of lung cancer. Methods Serum CEA, CA125, CA199, CYFRA21-1 and NSE were measured with RIA, ehromatometrychemoluminescence, ELISA and biochemoluminescence methods respectively in 340 patients with lung cancers at different TNM stages, 120 patients with benign lung diseases, and 45 healthy people. The sensitivities, specificities and accuracies of different combination of those markers for the diagnosis of lung cancers were compared. Results CYFRA21-1 had the highest sensitivity and accuracy （60. 0% and 70. 3%） and CA199 had the highest specificity （99.4%） for detecting lung cancers, CYFRA21-1 had the highest sensitivity （79. 6%） for detecting squamous carcinoma. CEA had the highest sensitivity of （75. 7%） for detecting adenocarcinoma. NSE had the highest sensitivity （76.2%） for detecting small cell lung cancers （SCLC）. The combination of several serum tumor markers had higher sensitivities than the single marker for the diagnosis of lung cancers. With two markers, the combination of CYFRA21-1 and NSE had the highest sensitivity and accuracy （82. 9% and 83. 4%）, while the combination of CA125 and CA199 had the highest specificity （94. 5%）. With three markers, the combination of CEA, NSE and CYFRA21-1 had the highest sensitivity and accuracy （89.1% and 85. 1%）, while the combination of CEA, CA125 and CA199 had the highest specificity （86. 7%）. The combination of CEA, CA125, CA199, CYFRA21-1 and NSE produced the best value, with a sensitivity of 93.8%, a specificity of 71. 5%,and an accuracy of 86. 5%. Conclusion Serum CEA, CA125, CA199, CYFRA21-1 and NSE are helpful markers for the diagnosis of lung cancer. The combination of the markers can improve the sensitivity and accuracy of the diagnosis.

关 键 词：肺癌 肿瘤标志物 癌胚抗原 糖类癌抗原125 糖类癌抗原199 细胞角蛋白-19片断抗原 神经元特异性烯醇化酶 

分 类 号：R734.2[医药卫生—肿瘤]