肿瘤标记物与肺间质纤维化的相关性分析及临床观察

发布时间：2017-12-31 04:23

本文关键词：肿瘤标记物与肺间质纤维化的相关性分析及临床观察　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本文旨在评估IPF患者血清肿瘤标记物升高的水平,分析比较IPF与慢性阻塞性肺疾病继发肺间质改变、结缔组织疾病相关性肺疾病之间血清肿瘤标记物水平的差异以及探讨IPF与肿瘤标记物的相关关系,为临床应用提供参考依据。方法:本文回顾性分析了2011年1月至2015年12月于大连医科大学附属第一医院以及大连医科大学附属第二医院住院的101例IPF患者的血清CEA、CYFRA21-1、CA19-9水平,并连续性收集同期住院确诊为肺腺癌(111例)、慢性阻塞性肺疾病继发性间质改变(COPD-ILD)(109例)、结缔组织疾病相关性肺疾病(CTD-ILD)(94例)的患者以及健康体检者(82例)的血清CEA、CYFRA21-1、CA19-9水平为对照组。所有纳入病例均无心、肝、肾、胃肠等脏器肿瘤证据。除肺癌组患者,其他各组患者均无肺部肿瘤证据。回顾性收集IPF组患者的动脉血气指标及肺功能检查指标包括用力肺活量(FVC)、用力肺活量占预计值百分比(FVC%pred)、一氧化碳弥散量(DLCO)、一氧化碳弥散量占预计值百分比(DLCO%pred)的结果。检测的血清CEA的参考值范围为0-5.0 ng/ml,检测的血清CYFRA211的参考值范围为0-3.3ng/ml,检测的血清CA19-9的参考值范围为0-27U/ml,超过参考值上限为阳性,在正常参考值范围内为阴性。阳性率(%)=血清肿瘤标记物水平超过参考上限的例数/总纳入例数。采用秩和检验分析比较各组患者血清肿瘤标记物水平的差异,并采用Spearman相关分析IPF患者血清肿瘤标记物水平与动脉血气及肺功能指标的相关性。结果:1.IPF组患者血清CEA、CA19-9阳性检出率分别为48.5%、51.2%,明显高于健康体检组、COPD-ILD组、CTD-ILD组;IPF组血清CYFRA21-1阳性检出率为71.7%,明显高于健康体检组、COPD-ILD组,而与CTD-ILD无明显差异。2.IPF组血清CEA、CA19-9水平分别为4.64(2.98,7.05)ng/ml、25.80(12.35,74.88)U/ml,明显高于健康体检组、COPD-ILD、CTD-ILD组;IPF组患者血清CYFRA21-1水平为4.49(3.21,6.09)ng/ml,明显高于健康体检组和COPD-ILD组,但与CTD-ILD组相比,差异无统计学意义。IPF组患者血清CEA水平明显低于肺腺癌组。3.各组患者各肿瘤标记物的最大值(95百分位数,即有95%的患者其肿瘤标记物在此数值范围内):IPF患者CEA、CYFRA21-1、CA19-9的最大值分别为12.54ng/ml、12.08ng/ml、251.85U/ml,COPD-ILD组CEA、CYFRA21-1、CA19-9的最大值分别为7.3ng/ml、5.84 ng/ml、34.7U/ml;CTD-ILD组CEA、CYFRA21-110.40ng/ml、CA19-9的最大值分别为10.95ng/ml、10.40ng/ml、140.0U/ml。4.将血清CEA水平根据血清浓度分为升高组和正常组,CEA升高组患者动脉血气、FVC%pred、DLCO%pred水平均明显低于正常组。5.血清CYFRA21-1水平与FVC%pred呈负相关,血清CA19-9水平与DLCO%pred呈负相关性。结论:1.IPF患者血清肿瘤标记物升高是一种常见现象,IPF患者CEA的参考范围上限为12.54ng/ml,在临床中,当CEA水平小于12.54ng/ml时,可能与IPF本身特点相关,当CEA水平高于上述范围时,更需高度警惕肺癌的发生。2.血清肿瘤标记物在IPF与COPD-ILD、CTD-ILD之间存在水平的差异,其差异可能对于IPF与这两种疾病鉴别有一定的提示作用。3.血清肿瘤标记物水平或可反映IPF患者病情严重程度。
[Abstract]:Objective: to assess the serum tumor markers in patients with IPF increased the level of analysis and comparison of IPF and chronic obstructive pulmonary disease secondary to pulmonary interstitial changes, serum tumor marker level differences between lung disease of connective tissue disease related correlation and to explore the relationship between IPF and tumor markers, and provide reference for clinical application. Methods: This paper analyzed retrospectively from January 2011 to December 2015 in the First Affiliated Hospital of Dalian Medical University and the Second Affiliated Hospital of Dalian Medical University hospital in 101 cases of IPF patients with serum CEA, CYFRA21-1, CA19-9 level, and continuously collected in the same period were diagnosed as lung adenocarcinoma (111 cases), chronic obstructive pulmonary disease complicated with interstitial changes (COPD-ILD (109) cases of lung disease), connective tissue disease association (CTD-ILD) (94 cases) patients and healthy subjects (82 cases). The serum levels of CEA, CYFRA21-1, CA19-9 level control Group. All the cases of liver, kidney, heart, gastrointestinal and other organs. In addition to evidence of tumor in lung cancer group, the other groups of patients had no evidence of lung cancer were collected retrospectively. The patients in the IPF group index of arterial blood gas and lung function indexes including forced vital capacity (FVC), forced vital capacity (FVC%pred percentage of predicted value), diffusion capacity of carbon monoxide (DLCO), carbon monoxide diffusion volume percentage of predicted value (DLCO%pred). The results of serum CEA detection of the reference ranges for 0-5.0 ng/ml, serum CYFRA211 detection reference range for 0-3.3ng/ml, serum CA19-9 detection of the reference range of 0-27U/ml, more than the maximum reference value was positive. In the normal reference range was negative. The positive rate (%) = D / serum tumor marker levels exceed the reference limit the total enrollment. Rank sum test was used to analyze the group compared with the serum levels of tumor markers The difference, and the correlation of Spearman correlation analysis of serum tumor markers in patients with IPF levels and arterial blood gas and lung function index. Results: in 1.IPF group, serum CEA, CA19-9 positive rates were 48.5%, 51.2%, significantly higher than the healthy group, COPD-ILD group, CTD-ILD group; IPF group serum CYFRA21-1 positive rate was 71.7%. Was significantly higher than healthy group, COPD-ILD group and.2.IPF group have no significant differences in serum CEA and CTD-ILD, CA19-9 levels were 4.64 (2.98,7.05) ng/ml, 25.80 (12.35,74.88) U/ml, was significantly higher than healthy group, COPD-ILD group, CTD-ILD group; CYFRA21-1 level of serum IPF was 4.49 (3.21,6.09) ng/ml, was significantly higher than healthy group and COPD-ILD group, but compared with the CTD-ILD group, the maximum value was no significant difference between.IPF group of serum CEA levels in patients with lung adenocarcinoma group.3. group of patients with different tumor markers were significantly lower than the 9 thousand and 500 percentile (i.e. There were 95% patients with tumor markers in this range of values): IPF patients with CEA, CYFRA21-1, the maximum value of CA19-9 were 12.54ng/ml, 12.08ng/ml, 251.85U/ml, COPD-ILD group CEA, CYFRA21-1, the maximum value of CA19-9 were 7.3ng/ml, 5.84 ng/ml, 34.7U/ml; group CTD-ILD CEA, CYFRA21-110.40ng/ml CA19-9, the maximum value was 10.95ng/ml 10.40ng/ml, 140.0U/ml.4., CEA serum levels according to serum concentrations were divided into increased group and normal group, CEA group were elevated arterial blood gas, FVC%pred, DLCO%pred were significantly lower than normal group.5. was negatively correlated with the level of serum CYFRA21-1 and FVC%pred, there was a negative correlation between the serum level of CA19-9 and DLCO%pred. Conclusion: 1.IPF serum tumor markers in the patients with elevated a common phenomenon, the upper limit of the reference range of IPF CEA in patients with 12.54ng/ml in clinical practice, when the CEA level is less than 12.54ng/ml, may be associated with the IPF itself, when CEA The level is higher than the range, more need to be highly vigilant in lung cancer.2. serum tumor markers in IPF and COPD-ILD, there are differences in the level of CTD-ILD, the difference may be due to the IPF and identify the two diseases with serum tumor markers of.3. indicate a certain level may reflect the severity of IPF.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2;R563

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