肺癌患者血清肿瘤标志物与凝血功能变化相关性研究  

Research on the association of serum tumor markers and coagulation function changes in lung cancer patients

作　　者：杨桂学 吴卓[1] 张磊[1] 李冉华 徐宝宁[1] 曾涛 Yang Guixue;Wu Zhuo;Zhang Lei;Li Ranhua;Xu Baoning;Zeng Tao(Department of Thoracic Surgery,The Fourth Affiliated Hospital of China Medical University,Liaoning Shenyang 110033,China)

机构地区：[1]中国医科大学附属第四医院胸外科,辽宁沈阳110033

出　　处：《现代肿瘤医学》2018年第16期2519-2523,共5页Journal of Modern Oncology

基　　金：辽宁省科学技术计划项目(编号:2013408001)

摘　　要：目的:探讨肺癌患者血清肿瘤标志物和血浆凝血功能变化的相关性及其临床意义。方法:对157例肺癌患者、56例良性肺疾病患者和40例健康人进行回顾性研究,检测血清癌胚抗原(CEA)、神经元特异烯醇化酶(NSE)、细胞角蛋白19片段(CYFRA21-1)以及血浆纤维蛋白原(FIB)、D-二聚体(D-D)、血小板(PLT),并对检测结果进行统计学分析。结果:肺癌组CEA、NSE、CYFRA21-1、FIB、D-D、PLT水平分别与良性肺疾病组和健康对照组比较差异均有统计学意义(P<0.05)。肺癌组各指标水平在高分期(Ⅲ/Ⅳ)组中均高于低分期(Ⅰ+Ⅱ)组(P<0.05),除了PLT水平在肺癌高分期(Ⅲ/Ⅳ)组与低分期(Ⅰ+Ⅱ)组比较差异无统计学意义(P>0.05)。CYFRA21-1水平在Ⅳ_b期肺癌组中高于Ⅳ_a期组,差异有统计学意义(P<0.05);FIB水平与CYFRA21-1以及D-D分别与CEA、NSE、CYFRA21-1呈正相关;CEA对于肺癌诊断敏感性和特异性均最高,六项指标联合检测对肺癌诊断的敏感性(89.2%)和阴性预测值(64.6%)及对于非小细胞肺癌(NSCLC)诊断的曲线下面积(0.832),均高于任一单项指标检测。结论:联合检测肿瘤标志物和凝血功能变化对肺癌早期诊断和治疗有重要价值,以及有助于预测肺癌患者血栓形成风险,给予早期预防有重要的指导意义。Objective：To explore the association and clinical significance between serum tumor markers and plasma coagulation function changes in lung cancer patients.Methods：157 lung cancer patients,56 subjects with benign lung disease（BLD） and 40 healthy volunteers were included in this retrospective study.Serum carcinoembryonic antigen（CEA）,neuron specific enolase（NSE）,cytokeratin19 fragments（CYFRA21-1） and plasma fibrinogen（FIB）,platelet（PLT）,D-dimer（D-D） were measured.Results：CEA,NSE,CYFRA21-1 and FIB,D-D,PLT levels in lung cancer patients were statistically significant compared with BLD and healthy control group （P＜0.05）.All indexes levels were elevated in high stage（III/IV） than in lower stage（I＋II） （P＜0.05）,except for PLT between high stage（III/IV） and lower stage（I＋II）（P＞0.05）.Stage IVB lung cancer group CYFRA21-1 level were higher than that with IVA period（P＜ 0.05）.The plasma FIB levels were positively correlated with CYFRA21-1 and D-D levels were positively related to CEA,NSE,CYFRA21-1,respectively.The sensitivity（SE） and specificity（SP） of CEA was higher than the other markers.SE（89.2%） and negative predict value（NPV） （64.6%） of six kinds of markers jointed detection in lung cancer and area under the receiver-operating characterisitic（ROC） curve（AUC） in NSCLC were higher than that of every single marker.Conclusion：The combination of tumor markers and blood coagulation have important value for early diagnosis and treatment of lung cancer,and help to predict risk of thrombosis,and have great guidance significance for early prevention.

关 键 词：肺癌 肿瘤标志物 纤维蛋白原 D-二聚体 血小板 

分 类 号：R734.2[医药卫生—肿瘤]