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目的探讨肿瘤标志物CEA、DR70、NSE和CYFRA21-1单项和联合检测对肺癌诊断的价值,评价血清中4项标志物水平在肺癌不同病理类型及治疗前后的表达意义。方法采用酶联免疫法检测130例肺癌患者和50例肺部良性疾病患者血清4项标志物水平,并以100名健康人为对照。同时对其中80例肺癌患者进行治疗前后标志物水平检测。结果肺癌患者CEA、DR70、NSE和CYFRA21-1血清水平高于肺良性疾病患者和健康人,差异有显著性意义(均P<0.01),肺部良性疾病患者和健康人比较差异无显著性;4项标志物在肺癌不同病理类型中CEA和NSE总体比较均有差异,其中腺癌CEA水平均高于其他类型(P<0.05￣0.01),小细胞肺癌NSE水平高于其他类型(均P<0.01);治疗有效的肺癌患者治疗后4项标志物水平均明显下降,而治疗无效者治疗前后均无明显变化。4项标志物联合检测的敏感度(73.1%)和准确度(80.5%)明显高于单项敏感度(分别为45.4%、24.6%、36.2%、33.8%)及准确度(分别为65.7%、55.2%、63.5%、60.7%)。结论CEA、DR70、NSE和CYFRA21-1联合检测可明显提高肺癌的阳性检出率;联合检测对鉴别肺癌与肺部良性疾病、肺癌不同病理类型,尤其对未能取得病理和细胞学证实的肺癌患者有一定的参考价值。同时检测治疗后标志物水平可以评估预后,观察治疗效果,为临床医师选择和改进治疗方案提供依据。
Objective To investigate the value of single and combined detection of tumor markers CEA, DR70, NSE and CYFRA21-1 in the diagnosis of lung cancer and to evaluate the significance of the four markers in serum in different pathological types of lung cancer and before and after treatment. Methods Serum levels of 4 markers in 130 patients with lung cancer and 50 patients with benign lung diseases were detected by enzyme-linked immunosorbent assay (ELISA), and 100 healthy controls were used as controls. At the same time, 80 cases of lung cancer patients before and after treatment for the detection of marker levels. Results The serum levels of CEA, DR70, NSE and CYFRA21-1 in patients with lung cancer were significantly higher than those in patients with benign lung disease and healthy people (all P <0.01). There was no significant difference between the patients with benign lung diseases and healthy people. The CEA and NSE levels of all the four markers were different in different pathological types of lung cancer. The CEA levels in adenocarcinoma were higher than those in other types (P <0.05 ~ 0.01) and the levels of NSE in small cell lung cancer were higher than those in other types (all P < 0.01). The levels of all four markers in patients with effective lung cancer decreased significantly after treatment, but no significant changes were found in patients with ineffective treatment before and after treatment. The sensitivities (73.1%) and accuracy (80.5%) of the four markers were significantly higher than those of the single sensitivity (45.4%, 24.6%, 36.2% and 33.8%, respectively) 55.2%, 63.5%, 60.7%). Conclusions The combined detection of CEA, DR70, NSE and CYFRA21-1 can significantly improve the detection rate of lung cancer. Combined detection of lung cancer and benign lung disease, different pathological types of lung cancer, especially failed to obtain pathology and cytology confirmed lung cancer Patients have a certain reference value. At the same time, the level of markers after treatment can evaluate the prognosis, observe the therapeutic effect, and provide the basis for clinicians to choose and improve the treatment plan.