胸腔积液CEA、CA19-9、CYFRA21-1、AFP和FERR在肺癌诊断中的价值  

The value of CEA,CA19-9,CYFRA21-1,AFP and FERR detection in pleural effusion for the diagnosis of lung cancer

作　　者：廖君群[1] 

机构地区：[1]重庆医科大学附属第一医院检验科,重庆400016

出　　处：《国际检验医学杂志》2013年第10期1216-1218,共3页International Journal of Laboratory Medicine

基　　金：国家临床重点专科建设项目资助(财社[2010]305号)

摘　　要：目的探讨CEA、CA19-9等5种肿瘤标志物对不同组织类型肺癌的诊断价值,并确定其诊断分界值。方法采用电化学发光法(ECL)对412例肺部不同性质胸腔积液肿瘤标志物进行检测,并加以分析。结果肺部恶性胸腔积液CEA、CA19-9和CYFRA21-1水平明显高于良性胸腔积液(P<0.05),但AFP、FERR水平恶性组与良性组比较差异无统计学意义(P>0.05)。CEA浓度在腺癌中最高,且明显高于鳞癌和小细胞癌(P<0.01),而其他指标在三者之间比较差异无统计学意义(P>0.05)。根据ROC曲线选择5种肿瘤标志物在肺癌诊断中的最佳分界值(cut-off值),分别是4.835ng/mL、31.645U/mL、58.765ng/mL、1.105IU/mL、2 134.5ng/mL,其灵敏度(%)、特异度(%)、准确性(%)分别为:CEA(85.7、82.2、83.5),CA19-9(44.9、94.7、76.1),CYFRA21-1(56.5、81.8、72.3),AFP(74.8、47.8、57.9),FERR(33.3、74.9、59.4)。CEA与CA19-9联合检测其敏感度、特异度、准确度分别为90.5%、80.2%、84.0%。结论 CEA具有较高的灵敏度和特异度,且对腺癌有较高的特异度。CEA和CA19-9联合检测时可显著提高对恶性胸腔积液的诊断价值。Objective To evaluate the individual and combined diagnostic value of five tumor markers in patients with pleural effusions and lung cancer and to find a cut-off value of each marker.Methods Pleural effusion Carcinoembryonic Antigen（CEA）,carbohydrate antigen 19-9（CA19-9）,cytokeratin fragment 19（CYFRA21-1）,alpha-fetoprotein（AFP） and ferritin（FER） were assayed in 412 patients with ECL（electrochemical luminescence）.Results Pleural fluid level of CEA,CA19-9 and CYFRA21-1 except AFP and FERR in patients with malignant pleural effusions were significantly higher than those in patients with benign pleural effusions（P＆lt;0.05）.CEA was significantly higher in adenocarcinoma than in squamous cell carcinoma and small cell lung cancer.Using the cut-off values of 4.835 ng/mL,31.645 U/mL,58.765 ng/mL,1.105 IU/mL,2 134.5 ng/mL in CEA,CA19-9,CYFRA21-1,AFP and FERR,respectively,the sensitivity（%）,specificity（%） and efficiency（%） of these tumor markers in pleural fluid were as follows：CEA（85.7/82.2/83.5）,CA19-9（44.9/94.7/76.1）,CYFRA21-1（56.5/81.8/72.3）,AFP（74.8/47.8/57.9）FERR（33.3/74.9/59.4）.When CEA and CA19-9 combined,the sensitivity and specificity were 90.5% and 80.2% respectively.Conclusion In the diagnosis of malignant effusions associated with lung cancer,CEA was found to have the best sensitivity and good specificity in adenocarcinoma diagnosis and the combined detection of CEA and CA19-9 in pleural effusion could enhance diagnostic yield better than those other combinations.

关 键 词：肿瘤标志物 胸腔积液 肺癌 ROC曲线 

分 类 号：R734.2[医药卫生—肿瘤]