血清外泌体CEA、CA15-3和CA125水平在非小细胞肺癌和肺部良性病变鉴别诊断中的价值  

Roles of serum exosomal CEA,CA15-3 and CA125 in the differential diagnosis of non-small cell lung cancer and benign lung diseases

作　　者：崔晓阳 刘国栋 郭慧娟 廖志宏 刘运洪 张伟芬 陈子尧 魏晓珠 CUI Xiaoyang;LIU Guodong;GUO Huijuan;LIAO Zhihong;LIU Yunhong;ZHANG Weifen;CHEN Zirao;WEI Xiaozhu(Department of Clinical Laboratory,Shenzhen Longhua District People's Hospital,Shenzhen 518109,Guangdong,China)

机构地区：[1]深圳市龙华区人民医院检验科,广东深圳518109

出　　处：《检验医学》2024年第11期1035-1041,共7页Laboratory Medicine

基　　金：深圳市基础研究资助项目(JCYJ20210324131414040);深圳市龙华区医疗卫生机构区级科研项目(2020070)。

摘　　要：目的初步探讨血清外泌体中癌胚抗原(CEA)、糖类抗原(CA)15-3和CA125水平在非小细胞肺癌(NSCLC)和肺部良性病变鉴别诊断中的价值。方法选取2019年1月—2023年12月深圳市龙华区人民医院NSCLC患者152例[NSCLC组,包括NSCLC早期28例(NSCLC早期组)、NSCLC进展期124例(NSCLC进展期组)]和肺部良性病变患者86例(良性疾病组)。提取所有患者血清外泌体,并分别检测外泌体和血清中的CEA、CA15-3和CA125水平。采用受试者工作特征(ROC)曲线评价各项指标鉴别诊断NSCLC和肺部良性病变的效能。采用Logistic回归分析评估发生NSCLC的影响因素。基于外泌体3项肿瘤标志物构建鉴别诊断NSCLC和肺部良性病变的联合检测模型。采用校准曲线和决策曲线评估联合检测模型的临床价值。结果与良性疾病组比较,NSCLC组血清和外泌体CEA、CA15-3、CA125水平均显著增高(P<0.0001)。CEA、CA15-3、CA125的血清水平高于外泌体水平(P<0.05)。NSCLC组同一肿瘤标志物的血清水平与外泌体水平呈正相关(P<0.0001)。NSCLC早期组血清CEA、CA15-3、CA125水平均显著高于良性疾病组(P<0.05)。与NSCLC早期组比较,NSCLC进展期组血清CEA水平显著升高(P<0.05),血清CA15-3、CA125和外泌体CEA、CA15-3、CA125水平稍升高,但差异均无统计学意义(P>0.05)。血清CEA、CA15-3、CA125鉴别诊断NSCLC与肺部良性病变的曲线下面积(AUC)分别为0.7883、0.7896、0.6786,外泌体CEA、CA15-3、CA125的AUC分别为0.852、0.918、0.891。联合检测模型的区分度均较好(AUC为0.970),准确性较高(χ^(2)=5.2807,P=0.503),在高风险阈值(0.00~1.00)范围内的净获益率>0,净获益率最大值为0.703。结论血清外泌体CEA、CA15-3和CA125联合检测可用于NSCLC与肺部良性病变的鉴别诊断,具有较高的临床应用价值。Objective To investigate the roles of serum exosomal carcinoembryonic antigen(CEA),carbohydrate antigen(CA)15-3 and CA125 determinations in the differential diagnosis of non-small cell lung cancer(NSCLC)and benign lung diseases.Methods A total of 152 patients with NSCLC(28 cases of earlystage NSCLC and 124 cases of advanced NSCLC)and 86 patients with benign lung diseases were enrolled from Shenzhen Longhua District People's Hospital from January 2019 to December 2023.The exosomes in serum were extracted,serum and exosomal levels of CEA,CA15-3 and CA125 were determined.The diagnostic performance was assessed by receiver operating characteristic(ROC)curve.Logistic regression analysis was used to evaluate the risk factors of NSCLC.A combined determination model for differentiating NSCLC from benign lung diseases was constructed based on the 3 tumor markers in exosomes.Calibration curve and decision curve were used to evaluate the role of combined determination model.Results Compared with benign group,serum and exosomal levels of CEA,CA15-3 and CA125 in NSCLC group were increased(P<0.0001).The serum levels of CEA,CA15-3 and CA125 were higher than exosomal levels(P<0.05).The serum levels and exosomal levels in NSCLC group showed a positive correlation(P<0.0001).The serum levels of CEA,CA15-3 and CA125 in early-stage NSCLC group were higher than those in benign group(P<0.05).Compared with early-stage NSCLC group,serum CEA level in advanced NSCLC group was increased(P<0.05),while serum CA15-3,serum CA125,exosomal CEA,exosomal CA15-3 and exosomal CA125 levels were slightly increased(P>0.05).The areas under curves(AUC)for serum CEA,CA15-3 and CA125 in differentiating NSCLC from benign lung diseases were 0.7883,0.7896 and 0.6786,respectively,while the AUC for exosomal CEA,CA15-3 and CA125 were 0.852,0.918 and 0.891,respectively.The combined determination model had good discrimination(AUC=0.970).The accuracy of the combined determination model was high(χ^(2)=5.2807,P=0.503),and the net benefit rate was>0 within the high-ri

关 键 词：癌胚抗原 糖类抗原15-3 糖类抗原125 外泌体 非小细胞肺癌 

分 类 号：R446.1[医药卫生—诊断学]