摘要目的 探讨肿瘤标志物CEA、CA125、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段抗原(CYFRA21-1)联合检测在肺癌中的诊断价值.方法 研究对象为2010年10月至2012年3月的确诊肺癌住院患者138例(男82例,女56例,平均年龄58.6岁),肺良性病变住院患者96例(男56例,女40例,平均年龄51.3岁)；健康体格检查者45名(对照组,男30名,女15名,平均年龄43.9岁).用电化学发光法检测血清CEA、CA125、NSE和CYFRA21-1水平,各指标的组间比较采用单因素方差分析及q检验.按病理类型分组,对鳞状细胞癌[简称鳞癌(66例)]、腺癌(52例)和小细胞肺癌(20例)的肿瘤标志物水平进行比较,计算单项及联合检测对各类型肺癌的诊断效能.结果 肺癌组血清CEA、CA125、NSE、CYFRA21-1水平均高于肺部良性病变组和健康对照组[CEA:(19.99±30.99)、(10.78± 19.77)、(3.25±3.42) μg/L,CA125:(79.70±95.98)、(44.96±44.97)、(20.66±7.13) μg/L,NSE:(35.23±40.22)、(15.31±8.42)、(13.30± 5.65) μg/L,CYFRA21-1:(18.07±43.71)、(8.30±8.83)、(3.13±1.60) μg/L；F=4.481、5.436、4.776和6.002,均P＜0.05].CEA在腺癌中水平较鳞癌和小细胞肺癌高(F=4.932,P＜0.05),NSE在小细胞肺癌中水平较高(F=5.119,P＜0.05),CYFRA21-1在鳞癌中水平较高(F=5.378,P＜0.05).单项肿瘤标志物在肺癌诊断中灵敏度:鳞癌中CYFRA21-1灵敏度最高(78.8％,52/66),腺癌中CEA灵敏度最高(57.7％,30/52),而在小细胞肺癌中NSE灵敏度最高(75.0％,15/20).在联合检测中CEA+CYFRA21-1+ NSE组合对鳞癌诊断灵敏度最高(89.4％,59/66),腺癌诊断中CEA+CA125+NSE组合灵敏度最高(78.8％,41/52),小细胞肺癌中CEA+CYFRA21-1+NSE组合灵敏度最高(80.0％,16/20).结论 CEA、CA125、NSE、CYFRA21-1联合检测对肺癌的诊断有一定的临床价值,不同病理类型肺癌4种肿瘤标志物表达有所不同.

abstractsObjective To investigate the diagnostic value of combined detection of serum tumor markers,including CEA,CA125,neuron-specific enolase (NSE) and cytokeratin fragment antigen 21-1 (CYFRA21-1) for lung cancer patients.Methods The subjects involved 138 diagnosed lung cancer patients (82 males,56 females,average age 58.6 years,from October 2010 to March 2012),96 patients with benign lung diseases (56 males,40 females,average age 51.3 years) and 45 healthy adults (30 males,15females,average age 43.9 years).The pathological types of lung cancer consisted of 66 squamous cell carcinoma (SCC),52 adenocarcinoma and 20 small cell lung cancer (SCLC).The serum levels of CEA,CA125,NSE and CYFRA21-1 were measured with electrochemiluminescence immunoassay.The diagnostic efficacy for different pathological types was compared among each single tumor marker and combination of tumor markers.One-way analysis of variance q test were used for statistical analysis.Results The serum levels of CEA,CA125,NSE and CYFRA21-1 in patients with lung cancer were higher than those in patients with benign lung diseases and in healthy subjects (CEA:(19.99±30.99),(10.78±19.77),(3.25±3.42) μg/L;CA125:(79.70±95.98),(44.96±44.97),(20.66±7.13) μg/L; NSE:(35.23±40.22),(15.31±8.42),(13.30±5.65) μg/L; CYFRA21-1:(18.07±43.71),(8.30±8.83),(3.13±1.60) μg/L; F=4.481,5.436,4.776,6.002,all P＜0.05).The highest level of CEA,NSE or CYFRA21-1 were found in adenocarcinoma (F=4.932,P＜0.05),SCLC (F=5.119,P＜0.05) or SCC (F=5.378,P＜0.05),respectively.The highest sensitivity tumor markers for SCC,SCLC and adenocarcinoma were CYFRA21-1 (78.8％,52/66),NSE (75.0％,15/20) and CEA (57.7％,30/52),respectively.In combined detection,the highest sensitivity combinations for SCC,SCLC and adenocarcinoma were CEA+CYFRA21-1+NSE (89.4％,59/66),CEA+CYFRA21-1+NSE (80.0％,16/20) and CEA+CA125+NSE (78.8％,41/52),respectively.Conclusions Combined detection of serum tumor markers is more sensitive for the diagnosis of lung cancer.The expressions of the above four tumor markers is correlated with pathological types of lung cancer.