多种肿瘤标志物在肺癌与肺结核中的诊断及鉴别诊断  

Diagnosis and Differential Diagnosis of Multiple Tumor Markers in Lung Cancer and Pulmonary Tuberculosis

作　　者：王亚楠[1] 张婷[1] 田娟 苗琪 WANG Yanan;ZHANG Ting;TIAN Juan;MIAO Qi(Department of Nuclear Medicine,The Eighth Medical Center of PLA General Hospital,Beijing 100091,China)

机构地区：[1]解放军总医院第八医学中心核医学科,北京100091

出　　处：《标记免疫分析与临床》2020年第10期1694-1700,共7页Labeled Immunoassays and Clinical Medicine

摘　　要：目的分析癌胚抗原(carcinoembryonic antigen,CEA)、细胞角蛋白19片段(cytokeratin 19 fragment,CYFRA21-1)、神经元特异性烯醇化酶(neuron-specific-enolase,NSE)、胃泌素释放前体(progastrin releasing peptide,Pro-GRP)、鳞状上皮细胞癌抗原(squamous cell carcinoma antigen,SCC)、糖类抗原CA125(carbohydrate antigen 125,CA125)在肺癌及肺结核中的诊断及鉴别诊断价值。方法应用电化学发光法选取本院138例肺癌患者、138例肺结核患者作为研究对象,138例健康体检者作为健康对照组,测定CEA、CYFRA21-1、NSE、Pro-GRP、SCC、CA125水平,评估其检测在肺癌与肺结核中的诊断价值。结果肺癌组患者血清CEA、CYFRA21-1、NSE、Pro-GRP、SCC水平明显高于肺结核组患者及健康对照组,肺结核患者CA125水平明显高于肺癌患者及健康对照组,小细胞肺癌(small cell lung cancer,SCLC)组中Pro-GRP、NSE水平显著高于非小细胞肺癌(non-small cell lung cancer,NSCLC)组,NSCLC组中CYFRA21-1、SCC、CA125水平明显高于SCLC组,腺癌组CEA、CA125水平明显高于鳞癌组,鳞癌组CYFRA21-1、SCC水平明显高于腺癌组,差异均具有统计学意义(P<0.05)。经受试者工作特征曲线(ROC曲线)分析可知,6项肿瘤标志物联合检测肺癌的ROC曲线下面积(area under curve,AUC)可达到0.993,灵敏度提高至96.4%,优于各指标单独检测,且与肺结核组联合检测比较具有统计学意义(P<0.05)。单独检测时,CA125在诊断肺结核的AUC为0.928,灵敏度为81.9%,优于其他指标;SCLC组NSE、Pro-GRP的AUC分别高达0.938、0.961,灵敏度分别为85%、92.5%;CYFRA21-1、SCC诊断鳞癌的AUC为0.977,0.933,灵敏度为90.9%、87.9%,明显优于其他指标;CEA诊断腺癌的AUC为0.957,其灵敏度为89.2%,高于其他指标。结论患者体内的肿瘤标志物水平与其良恶性及病理类型有关,联合多种肿瘤标志物检测更有利于临床诊断。Objective To explore the value of carcinoembryonic antigen(CEA),cytokeratin 19 fragment(CYFRA21-1),neuron-specific-enolase(NSE),progastrin releasing peptide(Pro-GRP),squamous cell carcinoma antigen(SCC),and carbohydrate antigen 125(CA125)in the diagnosis and differential diagnosis of lung cancer and pulmonary tuberculosis.Methods The levels of CEA,CYFRA21-1,NSE,Pro-GRP,SCC and CA125 in serum of 138 patients with lung cancer,138 patients with pulmonary tuberculosis and 138 health examiners(controls)were measured by electrochemical method,and the results were used to evaluate its diagnostic value in lung cancer and pulmonary tuberculosis.Results The serum levels of CEA,CYFRA21-1,NSE,Pro-GRP and SCC in patients with lung cancer were significantly higher than those of pulmonary tuberculosis patients and the healthy control group.The serum level of CA125 in patients with pulmonary tuberculosis was significantly higher than those of patients with lung cancer and healthy control group.The level of Pro-GRP,NSE in patients with small cell lung cancer(SCLC)were significantly higher than patients with non-small cell lung cancer(NSCLC).The level of CYFRA21-1,SCC,and CA125 in NSCLC were significantly higher than SCLC.The level of CEA and CA125 in the adenocarcinoma group were significantly higher than the squamous cell carcinoma group,while the levels of CYFRA21-1 and SCC in the squamous cell carcinoma group were significantly higher than the adenocarcinoma group(P<0.05).The ROC curve analysis showed that the area under the curve(AUC)of combined detection of 6 tumor markers were 0.993 and the sensitivity was increased to 96.4%,which was superior to that of single-index detection,and combined detection was statistically significant compared with the pulmonary tuberculosis group(P<0.05).When tested separately,the AUC of CA125 in the diagnosis of tuberculosis was 0.928 and the sensitivity was 81.9%,which was significantly superior to other indexes.The AUC of NSE and Pro-GRP in the SCLC group were 0.961 and 0.938,and the sensitiv

关 键 词：肺癌 肿瘤标志物 肺结核 小细胞肺癌 非小细胞肺癌 

分 类 号：R734.2[医药卫生—肿瘤]