[1]张利祥,潘 静,赵 洁,等.痰液基细胞学检查与血清CYFRA21-1,CEA,NSE联合检测对肺癌的诊断价值[J].现代检验医学杂志,2019,34(03):99-103.[doi:10.3969/j.issn.1671-7414.2019.03.024]
　ZHANG Li-xiang,PAN Jing,ZHAO Jie,et al.Value of the Combined Determination of Sputum Liquid-Based Cytologyand Serum CYFRA21-1,CEA,NSE for the Diagnosis of Lung Cancer[J].Journal of Modern Laboratory Medicine,2019,34(03):99-103.[doi:10.3969/j.issn.1671-7414.2019.03.024]
点击复制

痰液基细胞学检查与血清CYFRA21-1,CEA,NSE联合检测对肺癌的诊断价值()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第34卷
期数:
2019年03期
页码:
99-103
栏目:
论著
出版日期:
2019-06-20

文章信息/Info

Title:
Value of the Combined Determination of Sputum Liquid-Based Cytologyand Serum CYFRA21-1,CEA,NSE for the Diagnosis of Lung Cancer
文章编号:
1671-7414(2019)03-099-05
作者:
张利祥1; 潘 静2; 赵 洁1; 叶英姿1; 李中华1
(1.中国人民武装警察部队烟台特勤疗养中心,山东烟台 264000; 2.中国人民解放军陆军军医大学西南医院检验科,重庆 400000)
Author(s):
ZHANG Li-xiang1; PAN Jing2; ZHAO Jie1; YE Ying-zi1; LI Zhong-hua1
(1.Yantai Special Care Center,the Chinese People's Armed Police Force,Shandong Yantai 264000,China; 2.Department of Clinical Laboratory,Southwest Hospital of PLA Army Medical University,Chongqing 400000,China)
关键词:
肺癌;  痰液基细胞学检查;  癌胚抗原;  细胞角蛋白19片段;  神经元特异性烯醇化酶
分类号:
R734.2; R730.43
DOI:
10.3969/j.issn.1671-7414.2019.03.024
文献标志码:
A
摘要:
目的 探究痰液基细胞学检查(sLCT)与血清细胞角蛋白19片段(CYFRA21-1)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)联合检测对肺癌的诊断价值。方法 选取西南医院确诊的肺癌患者89例为研究对象(鳞癌29例,腺癌20例,小细胞肺癌32例,大细胞癌8例),另取肺部一般性疾病患者50例为对照组。所有患者均进行血清三项肿瘤标志物(CEA,CYFR21-1,NSE)和3次晨痰(sLCT)检测。根据数据分布采用相应统计学方法,运用受试者工作特征ROC曲线综合评价各项指标对肺癌的诊断价值。结果 CEA在肺癌患者中普遍升高,此外,肺鳞癌、腺癌和大细胞癌的血清CYFR21-1水平均高于对照组,小细胞肺癌的血清NSE水平亦高于对照组,差异均有统计学意义(t=2.144～7.467,均P<0.05)。鳞癌的CYFR21-1,腺癌的CEA,小细胞肺癌的NSE均高于其余各组水平,差异均有统计学意义(F=2.54～12.31,P<0.05)。sLCT诊断肺癌灵敏度和特异度分别为0.696和0.960。CEA+CYFR21-1+sLCT组合对肺鳞癌和大细胞癌诊断的ROC曲线下面积最高(AUC分别为0.921和0.897),CEA+CYFRA21-1和CEA+NSE+sLCT组合分别具有诊断肺腺癌和小细胞肺癌的最高ROC曲线下面积(AUC分别为0.853和0.907),且均高于同组其余检测结果(F=2.97～21.22,P<0.05)。结论 CEA是肺癌的广谱标志物,CYFR21-1和NSE可分别作为诊断肺鳞癌与小细胞肺癌的最佳血清指标。sLCT与血清肿瘤标志物联合检测可有效提高中央型肺癌的诊断效能,其中CEA+CYFR21-1+sLCT是诊断肺鳞癌和大细胞癌的最佳组合,CEA+CYFRA21-1和CEA+NSE+sLCT分别是诊断肺腺癌和小细胞肺癌的最佳组合。
Abstract:
Objective To investigate the value of the combined determination of sputum liquid-based cytology(sLCT)and serum cytokeratin 19 fragment(CYFRA21-1),carcinoembryonic antigen(CEA),neuron specific enolase(NSE)for the diagnosis of lung cancers.Methods Collected89 patients with diagnosed lung cancer as the subject of our study( squamous carcinoma 29 cases,adenocarcinoma 20 cases,small cell lung cancer 32 cases,large cell carcinoma 8 cases)and 50 patients with lung common disease as control group from the Southwest Hospital.They all had to test serum tumor markers(CYFRA21-1,CEA,NSE)and 3 times of sputum liquid-based cytology.Corresponding statistics tests were used according to data distribution,receiver operating characteristic(ROC)curve were used to assess the diagnostic efficiency of each index.Results CEA generally increased in lung cancers,besides,the levels of serum CYFR21-1 in squamous carcinomas,adenocarcinomasand largecell carcinomas were all higher than that of control group,NSE in small cell lung cancers was higher than that of control group(t=2.144～7.467,all P<0.05),respectively.The levels of CYFR21-1 in squamous carcinomas,CEA inadenocarcinomas and NSE in small cell lung cancers were extremely higher than that of any other groups(F=2.54～12.31,all P<0.05),respectively.The sensitivity and specificity of sLCT were 0.696 and 0.960 for diagnosis of lungcancers.The area under ROC curve of CEA+CYFR21-1+sLCT for the diagnosis of squamouscarcinomas and large cell carcinomas was the largest(AUC were 0.921 and 0.897 in turn),the CEA+CYFRA21-1 and CEA+NSE+sLCT had its own largest area under ROC curve for diagnosis of adenocarcinomas and small cell lung cancers respectively(AUC were 0.853 and 0.907 in turn),they were apparently higher than other test indices in same group(F=2.97～21.22,all P<0.05).Conclusion CEA was a broad-spectrum of tumor marker in lung cancers,CYFR21-1 and NSE can be used as best indicators in the diagnosis of squamous carcinomas and small cell lung cancers respectively.The efficiency of diagnosis of central type of lung cances by sLCT can be improved with conbining serum tumor markers,CEA+CYFR21-1+sLCT was the best combination for diagnosis of squamous carcinomas and large cell carcinomas,CEA+CYFRA21-1 and CEA+NSE+sLCT were the best combinations for diagnosis of adenocarcinomas and small cell lung cancers respectively.

参考文献/References:

[1] 李晓强,杜娟,褚笑眉.痰液基薄层细胞学技术与传统涂片方法诊断肺癌价值的比较研究[J].国际检验医学杂志,2011,32(21):2512-2513. LI Xiaoqiang,DU Juan,CHU Xiaomei.The comparing study of sputum liquid-based cytological test and traditional smear method for the diagnostic significance of lung cancer[J].Int J Lab Med,2011,32(21):2512-2513.
[2] WU Guangping,WANG Enhua,LI Jianhua,et al.Cli-nical application of theliquid-based cytological test in cytological screening of sputum for the diagnosis of lung cancer[J].Respirology,2009,14(1):124-128.
[3] JIANG Z F,WANG M,XU J L.Thymidine kinase1 combined with CEA,CYFRA21-1 and NSE improved its diagnostic value for lung cancer[J].Life Sci,2018,194(1):1-6.
[4] 倪军,郭子健,张力.单独与联合检测四项肺癌血清肿瘤标志物在肺癌诊断中的价值[J].中华内科杂志,2016,55(1):25-30. NI Jun,GUO Zijian,ZHANG Li.The diagnostic significance of singleor combination lung cancer-related serum biomarkers in high risk lungcancer patients[J].Chin J Intern Med,2016,55(1):25-30.
[5] MOHAN A,POULOSE R,ANSARI A,et al.Novel use of bioelectric impedence technique to detect alterations in body composition in advanced small cell lung cancer[J].Indian J Cancer,2017,54(2):478-480.
[6] FAN Yibo,WANG Qingshan,Ye Lin,et al.Clinical application of the SurePath liquid-based Pap test in cytological screening of bronchial brushing for the diagnosis of lung cancer[J].Cytotechnology,2010,62(1):53-59.
[7] 戚娟,刘蕊.肺癌诊断中痰液基薄层细胞学检查的应用体会[J].中国伤残医学,2013,21(11):304-305. QI Juan,LIU Rui.The application experience of sputum liquid-basedcytological test for the diagnosis of lung cancer[J].Chinese Journal of Trauma and Disbility Medicine,2013,21(11):304-305.
[8] 卢珊珊,曹箭,潘秦镜,等.痰液基薄层技术在肺癌诊断中的价值及影响因素分析[J].中国医刊,2010,45(1):44-46. LU Shanshan,CAO Jian,PAN Qinjing,et al.Value of thinprep sputumcytology in the diagnosis of lung carcers and its influencing factors[J].Chinese Journal of Medicine,2010,45(1):44-46.
[9] 董正伟,王彦丽,武春燕,等.液基细胞学检查系统在肺癌诊断中的价值[J].癌变·畸变·突变,2011,23(3):232-234. DONG Zhengwei,WANG Yanli,WU Chunyan,et al.Diagnostic value of liquid-based cytologc test in lung canaer[J].Carcinogenesis·Teratogenesis·Mutagenesis,2011,23(3):232-234.
[10] TSOUKALAS N,KOSTAKIS I D,GIAGINIS C,et al.Carcinoembryonic antigen and carbohydrate antigen 19-9 serum levels in non-small cell lung cancer[J].J of BUON,2017,22(6):1390-1394.
[11] DU Qiang,YAN Cunling,WU Sangang,et al.Development and validation ofa novel diagnostic nomogram model based on tumor markers for assessing cancer risk of pulmonary lesions:A multicenter study in Chinese population[J].CancerLetters,2018,420(2):236-241.
[12] WANG Qunhui,ZHENG Hua,HU Fanbin,et al.Serum CYFRA21-1 is correlatedwith the efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor in non-small cell lung cancer patients harboring EGFR mutations[J].ChineseJournal of Lungcancer,2016,19(8):550-558.
[13] QI Daliang,WANG Huaqing,LI Yan,et al.Efficacy and adverse effets ofnimotuzumab plus palitaxel liposome and carboplatin in the treatment for advanced non-small cell lung cancer[J].Chinese Journal of Oncology,2012,34(2):152-155.
[14] 陈元菁,顾晔.肺泡灌洗液中CEA,CYFR21-1,NSE联合检测对早期肺癌的诊断价值[J].国际检验医学杂志,2016,37(3):344-345,348.CHEN Yuanjing,Gu Ye.Diagnostic value of combination detection of CEA,CYFR21-1,NSE in bronchoalveolar lavage fluid for early lung cancer[J].Int J Lab Med,2016,37(3):344-345,348.
[15] ZHOU Fei,HOU Likun,DING Ting,et al.Distinct clinicopathologic features,genomic characteristics and survival of central and peripheral pulmonary large cell neuroendocrine carcinoma:From different origin cells?[J].Lung Cancer,2018,116(2):30-37.

相似文献/References:

[1]马丽颜,梁 静,周建龙.腺瘤样结肠息肉易感基因(APC)及结直肠癌缺失基因(DCC)基因甲基化在肺癌早期诊断的意义[J].现代检验医学杂志,2016,31(01):17.[doi:10.3969/j.issn.1671-7414.2016.01.005]
　MA Li-yan,LIANG Jing,ZHOU Jian-long.Evaluation of the Combination of APC and DCC Gene Methylation in the Early Diagnosis of Lung Cancer[J].Journal of Modern Laboratory Medicine,2016,31(03):17.[doi:10.3969/j.issn.1671-7414.2016.01.005]
[2]彭 瑛,邓正华,温先勇.国内13种血清肿瘤标志物对肺癌诊断价值的Meta分析[J].现代检验医学杂志,2016,31(01):96.[doi:10.3969/j.issn.1671-7414.2016.01.028]
　PENG Ying,DENG Zheng-hua,WEN Xian-yong.Diagnostic Value of Thirteen Types of Serum Tumor Markers for Lung Cancer in China:A Meta-Analysis[J].Journal of Modern Laboratory Medicine,2016,31(03):96.[doi:10.3969/j.issn.1671-7414.2016.01.028]
[3]翟海军,朱晶.红细胞分布宽度对肺癌预后的临床分析[J].现代检验医学杂志,2015,30(06):147.[doi:10.3969/j.issn.1671-7414.2015.06.045]
　ZHAI Hai-jun,ZHU Jing.Clinical Analysis of Red Blood Cell Distribution Width on the Prognosis of Lung Cancer[J].Journal of Modern Laboratory Medicine,2015,30(03):147.[doi:10.3969/j.issn.1671-7414.2015.06.045]
[4]姜 波,王玉明,段 勇.肺癌组织中调控PUMA基因 的miRNA筛查和MiR-221表达差异研究[J].现代检验医学杂志,2015,30(01):15.[doi:10.3969/j.issn.1671-7414.2015.01.005]
　JIANG Bo,WANG Yu-ming,DUAN Yong.Study on the Differential Expression of miRNA Screening and MiR-221 Regulates Apoptosis by Targeting PUMA Gene in Lung Cancer[J].Journal of Modern Laboratory Medicine,2015,30(03):15.[doi:10.3969/j.issn.1671-7414.2015.01.005]
[5]赵车冬,闫玉珠,吴文婧,等.血清CEA,CYFRA21-1,NSE水平在肺癌诊断与分型中的应用价值[J].现代检验医学杂志,2016,31(06):59.[doi:10.3969/j.issn.1671-7414.2016.06.016]
　ZHAO Che-dong,YAN Yu-zhu,WU Wen-jing,et al.Application Value of Serum CEA,CYFRA21-1 and NSE Levels in the Diagnosis and Typing of Lung Cancer[J].Journal of Modern Laboratory Medicine,2016,31(03):59.[doi:10.3969/j.issn.1671-7414.2016.06.016]
[6]董 莉,张保平,冯新平,等.血浆HSP90α检测在肺癌诊断中的临床应用价值研究[J].现代检验医学杂志,2017,32(04):97.[doi:10.3969/j.issn.1671-7414.2017.04.027]
　DONG Li,ZHANG Bao-ping,FENG Xin-ping,et al.Plasma HSP90 Alpha Testing Clinical Application Value in the Diagnosis of Lung Cancer Researc[J].Journal of Modern Laboratory Medicine,2017,32(03):97.[doi:10.3969/j.issn.1671-7414.2017.04.027]
[7]樊　华,弥　鹏,杨　波,等.肺癌患者外周血血小板参数检测分析及临床意义[J].现代检验医学杂志,2019,34(06):97.[doi:10.3969 ／ j.issn.1671-7414.2019.06.024]
　FAN Hua,MI Peng,YANG Bo,et al.Analysis and Clinical Value of Peripheral Platelet Parameters in Lung Cancer Patients[J].Journal of Modern Laboratory Medicine,2019,34(03):97.[doi:10.3969 ／ j.issn.1671-7414.2019.06.024]
[8]赵格a,高琼b,余宗涛a,等.肺癌患者血浆miR-3151 表达水平与临床病理特征的相关性研究[J].现代检验医学杂志,2020,35(05):28.[doi:10.3969/j.issn.1671-7414.2020.05.008]
　ZHAO Gea,GAO Qiongb,YU Zong-taoa,et al.Study on the Correlation between the Expression of miR-3151 in Plasma and Clinicopathological Features in Patients with Lung Cancer[J].Journal of Modern Laboratory Medicine,2020,35(03):28.[doi:10.3969/j.issn.1671-7414.2020.05.008]
[9]毛　俊,王　柯.老年肺癌患者肺切除术后血液 CRP，D- 二聚体，IL-17 水平与并发急性呼吸衰竭的相关性研究[J].现代检验医学杂志,2021,36(03):83.[doi:10.3969/j.issn.1671-7414.2021.03.019]
　MAO Jun,WANG Ke.Correlation of Blood CRP, D-dimer and IL-17 Levels with Acute RespiratoryFailure in Elderly Patients with Lung Cancer after Pneumonectomy[J].Journal of Modern Laboratory Medicine,2021,36(03):83.[doi:10.3969/j.issn.1671-7414.2021.03.019]
[10]李　辉,汪春新,秦明明,等.肺癌患者血清7项肿瘤标志物联合检测在病理分型及临床分期中的应用价值研究[J].现代检验医学杂志,2021,36(04):5.[doi:10.3969/j.issn.1671-7414.2021.04.002]
　LI Hui,WANG Chun-xin,QIN Ming-ming,et al.Study on the Application Value of Combined Detection of 7 Tumor Markersin Serum of Patients with Lung Cancer in Pathological Classificationand Clinical Staging[J].Journal of Modern Laboratory Medicine,2021,36(03):5.[doi:10.3969/j.issn.1671-7414.2021.04.002]

备注/Memo

备注/Memo:
作者简介:张利祥(1992-),男,大学本科,临床检验医师,初级职称,主要从事临床生化检验工作,E-mail:1035583410@qq.com。 通讯作者:李中华(1977-),男,副主任医师,主要从事肺癌的早期诊断,E-mail:lizhonghua107@163.com。 收稿日期:2018-07-24修回日期:2019-03-27
更新日期/Last Update: 2019-06-20