谢朝辉 方堃

[摘要] 目的 探討血清癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21-1）、胃泌素释放肽前体（ProGRP）和鳞状细胞癌抗原（SCC-Ag）标志物联合检测在肺癌诊断中的价值。 方法 选取2017年1～12月在成都市第一人民医院（以下简称“我院”）住院的158例肺癌患者为肺癌组（其中鳞癌组51例，腺癌组72例，小细胞癌组35例）；同期选取50名健康者为健康组，分别检测其血清中的CEA、NSE、CYFRA21-1、ProGRP和SCC-Ag水平，通过Logistic回归建立模型，用ROC曲线分析5种肿瘤标志物在肺癌诊断中的价值。 结果 肺癌组CEA、NSE、CYFRA21-1、ProGRP和SCC-Ag水平均明显高于健康组（P < 0.01）；小细胞癌组中NSE和ProGRP浓度最高，腺癌组CEA浓度最高，而鳞癌组SCC-Ag和CYFRA21-1浓度最高；Ⅲ～Ⅳ期肺癌患者5种肿瘤标志物的浓度明显高于Ⅰ～Ⅱ期患者，差异有统计学意义（P < 0.01）；联合检测Logistic回归模型曲线下面积为0.925，明显高于单一检测的面积。 结论 5种血清肿瘤标志物联合检测可提高肺癌诊断的准确性。

[关键词] 肺癌；癌胚抗原；鳞状细胞癌抗原；神经特异性烯醇化酶；细胞角蛋白19片段；胃泌素释放肽前体；联合检测

[中图分类号] R734.2 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0152-04

[Abstract] Objective To investigate the diagnostic value of combined detection of carcinoembry onic antigen （CEA）， neuron-specific enolase （NSE）， cytokeratin-19-fragment （CYFRA21-1）， pro-gastrin-releasing peptide （ProGRP）， and squamous cell carcinoma antigen （SCC-Ag） in lung cancer. Methods A total of 158 patients with lung cancer in the Chengdu First People′s Hospital from January to December 2017 were selected as lung cancer group（there were 51 cases of squamous cell carcinoma group， 72 cases of adenocarcinoma group and 35 cases of small cell carcinoma group）， and 50 healthy persons during the same period were selected as health group. The levels of CEA， NSE， CYFRA21-1， ProGRP， and SCC-Ag in serum were detected respectively. Logistic regression receiver operating characteristic curve were applied to analyze the data and evaluate the diagnostic values. Results The concentrations of CEA， NSE， CYFRA21-1， ProGRP and SCC-Ag in lung cancer group were significantly higher than those in the healthy group （P < 0.01）. The serum levels of NSE and ProGRP were the highest in small cell carcinoma group. The concentration of CEA was the highest in adenocarcinoma group， while that of SCC-Ag and CYFRA21-1 in squamous cell carcinoma group. The levels of five markers in lung cancer patients with stage Ⅲ-Ⅳ were significantly higher than those with stage Ⅰ-Ⅱ， the differences were statistically significant （P < 0.01）. The area under the curve of combined detection Logistic regression model was 0.925， which was significantly higher than that of single test. Conclusion The combined of 5 serum tumor markers can improve the accuracy of lung cancer diagnosis.

[Key words] Lung cancer； Carcinoembryonic antigen； Squamous cell carcinoma antigen； Neuron-specific enolase； Cytokeratin-19-fragments； Pro-gastrin-releasing peptide； Combined detection

肺癌是发病率和死亡率增长最快，对人群健康和生命构成重大威胁的恶性肿瘤之一。早期诊断具有重要的意义，是提高疗效，改善预后的关键。血清肿瘤标志物检测具有重复性好、操作简便的优点，在鉴别肺部肿瘤的性质、肺癌的早期诊断、疗效评价等方面具有较高的价值[1]，已成为肺癌早期筛查、疗效监测和预后判断的重要手段[2-4]。本研究将通过Logistic回归分析方法综合评价血清癌胚抗原（carcinoembryonic antigen，CEA）、神经元特异性烯醇化酶（neuron-specific enolase，NSE）、细胞角蛋白19片段（cytokeratin-19-fragment，CYFRA21-1）、胃泌素释放肽前体（pro-gastrin-releasing peptide，ProGRP）和鳞状细胞癌抗原（squamous cell carcinoma antigen，SCC-Ag）水平变化，分析多种肿瘤标志物联合检测在肺癌诊断中的价值。

1 资料与方法

1.1 一般资料

选择2017年1～12月在成都市第一人民医院（以下简称“我院”）住院的158例肺癌患者为研究对象。其中，男92例，女66例；……