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目的探讨血清肿瘤标志物神经原特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(SCC)、细胞角蛋白19片段抗原(CYFRA21-1)和癌胚抗原(CEA)在肺癌诊断中的应用价值。方法回顾性分析139例肺癌、98例肺良性疾病患者及78例健康体检者血清NSE、SCC、CYFRA21-1和CEA水平及相关临床资料。结果 (1)肺癌患者血清四种肿瘤标志物的水平均高于肺良性疾病组及健康对照组(P<0.05),肺良性疾病组与健康对照组间差异无统计学意义(P>0.05)。(2)NSE水平在小细胞肺癌(SCLC)组中最高,与肺鳞癌组和肺腺癌组相比差异有统计学意义(P<0.05);SCC和CYFRA21-1水平在肺鳞癌组中最高,与肺腺癌组和SCLC组相比差异有统计学意义(P<0.05);CEA水平在肺腺癌组中最高,与肺鳞癌组和SCLC组相比差异有统计学意义(P<0.05)。(3)NSE、CYFRA21-1和CEA联合检测肺癌灵敏度87.8%,特异性54.7%,该组合的约登指数最大(0.43);NSE和CEA联合检测在诊断肺腺癌中效能最高,灵敏度和特异性均为71.7%;CYFRA21-1和CEA联合检测肺鳞癌效能最高,灵敏度96.7%,特异性56.6%;NSE单项检测小细胞肺癌效能最高,灵敏度76.5%,特异性71.7%。(4)NSE、SCC、CYFRA21-1和CEA在肺癌检测中ROC曲线下面积分别为0.812、0.403、0.710、0.667。结论 NSE、SCC、CYFRA21-1和CEA对肺癌的诊断均有一定的价值,但单项肿瘤标志物检测的灵敏度和特异性存在局限性,联合检测可提高肺癌的诊断阳性率。
Objective To investigate the diagnostic value of serum tumor markers neuron specific enolase (NSE), squamous cell carcinoma antigen (SCC), cytokeratin 19 fragment antigen (CYFRA21-1) and carcinoembryonic antigen (CEA) Value. Methods The serum levels of NSE, SCC, CYFRA21-1 and CEA in 139 patients with lung cancer, 98 patients with benign pulmonary disease and 78 healthy controls were retrospectively analyzed. Results (1) The serum levels of four tumor markers in lung cancer patients were significantly higher than those in benign lung disease group and healthy control group (P <0.05), but there was no significant difference between benign lung disease group and healthy control group (P> 0.05) . (2) The level of NSE in SCLC group was the highest, which was significantly higher than that in lung squamous cell carcinoma group and lung adenocarcinoma group (P <0.05). The levels of SCC and CYFRA21-1 in lung squamous cell carcinoma group (P <0.05). The level of CEA was the highest in lung adenocarcinoma group and the difference was statistically significant compared with lung squamous cell carcinoma group and SCLC group (P <0.05) P <0.05). (3) NSE, CYFRA21-1 and CEA combined detection of lung cancer sensitivity 87.8%, specificity 54.7%, the combination of Youden index was the largest (0.43); NSE and CEA combined detection of lung adenocarcinoma in the diagnosis of the highest efficacy, sensitivity and specificity The positive rates of CYFRA21-1 and CEA in squamous cell carcinoma of the lung were 96.7% and 56.6%, respectively. The single cell lung cancer with NSE had the highest efficacy, sensitivity and specificity of 76.5% and 71.7%, respectively. (4) The area under the ROC curve of NSE, SCC, CYFRA21-1 and CEA in lung cancer detection were 0.812,0.403,0.710,0.667 respectively. Conclusion NSE, SCC, CYFRA21-1 and CEA are valuable in the diagnosis of lung cancer. However, the sensitivity and specificity of individual tumor markers have limitations. Combined detection can improve the diagnostic accuracy of lung cancer.