肺癌患者HE4和CEA、NSE、Pro-GRP、CYFRA21-1联合检测的临床意义

发布时间：2018-11-03 20:41

【摘要】：目的检测肺癌患者HE4、CEA、NSE、Pro-GRP和CYFRA21-1的表达水平,探讨其联合检测在肺癌诊断中的临床意义。方法选取2015年2月至2016年4月,在益都中心医院呼吸科入院诊治的125例肺癌患者作为研究对象,即肺癌组(包括腺癌65例,鳞癌40例,小细胞肺癌20例);同期选取40例肺部良性疾病者作为肺部良性疾病组和50健康体检者作为对照组。采用电化学发光法测定血清HE4、CEA、NSE、Pro-GRP和CYFRA21-1浓度水平,比较各组检测指标的水平差异及相关性;采用免疫组织化学法检测HE4在组织中的表达,并进行相关的统计学分析。结果①肺癌组患者血清HE4、CEA、NSE、Pro-GRP、CYFRA21-1水平显著增高,与肺部良性疾病组及对照组比较均有统计学差异(P0.01);但肺部良性疾病组与对照组比较,差异无统计学意义(P0.05);②肺癌组患者治疗后血清中HE4、CEA、NSE、Pro-GRP、CYFRA21-1浓度水平较治疗前明显降低,治疗前、后各项指标比较均有统计学差异(P0.01),但CEA、NSE、Pro-GRP仍高于对照组,与对照组比较有统计学差异(P0.05);③腺癌患者血清中HE4和CEA浓度水平明显高于鳞癌和小细胞肺癌(P0.01),小细胞肺癌患者血清中NSE和Pro-GRP浓度水平明显高于腺癌和鳞癌(P0.01),鳞癌患者血清CYFRA21-1浓度水平明显高于腺癌和小细胞肺癌(P0.01);④单一检测HE4、CEA、NSE、Pro-GRP、CYFRA21-1诊断肺癌的敏感性分别为63.2%、45.6%、29.6%、14.4%、28.8%;而联合检测5项肿瘤标志物诊断肺癌的敏感度可提高为90.4%;⑤免疫组织化学结果显示,HE4在腺癌、鳞癌和小细胞肺癌表达阳性率分别是78.5%、55%和10%。结论①联合检测血清HE4、CEA、NSE、Pro-GRP、CYFRA21-1可大大提高肺癌诊断和鉴别诊断的敏感率。②动态监测肺癌患者血清HE4、CEA、NSE、Pro-GRP和CYFRA21-1水平变化可为临床判断疗效和评估预后提供实验依据。③血清HE4水平可以作为辅助诊断肺癌的肿瘤标记物,值得临床推广应用。
[Abstract]:Objective to detect the expression of HE4,CEA,NSE,Pro-GRP and CYFRA21-1 in patients with lung cancer and to explore the clinical significance of combined detection in the diagnosis of lung cancer. Methods from February 2015 to April 2016, 125 patients with lung cancer (including 65 cases of adenocarcinoma, 40 cases of squamous cell carcinoma and 20 cases of small cell lung cancer) who were admitted to the Department of Respiratory Medicine of Yidu Central Hospital were selected as the study subjects. At the same time, 40 patients with benign pulmonary diseases were selected as control group and 50 healthy persons as control group. The levels of serum HE4,CEA,NSE,Pro-GRP and CYFRA21-1 were measured by electrochemiluminescence (ECL), and the difference and correlation of serum HE4,CEA,NSE,Pro-GRP and CYFRA21-1 in each group were compared. Immunohistochemical method was used to detect the expression of HE4 in tissues. Results 1 the serum HE4,CEA,NSE,Pro-GRP,CYFRA21-1 level in lung cancer group was significantly higher than that in benign pulmonary disease group and control group (P0.01). But there was no significant difference between the benign pulmonary disease group and the control group (P0.05). (2) the serum HE4,CEA,NSE,Pro-GRP,CYFRA21-1 level in lung cancer group was significantly lower than that before treatment (P0.01), but CEA,NSE,Pro-GRP was still higher than that in control group (P0.01). Compared with the control group, there was statistical difference (P0.05). 3 the levels of HE4 and CEA in patients with adenocarcinoma were significantly higher than those in squamous cell carcinoma and small cell lung cancer (P0.01), and the levels of NSE and Pro-GRP in serum of patients with small cell lung cancer were significantly higher than those of adenocarcinoma and squamous cell carcinoma (P0.01). The level of serum CYFRA21-1 in patients with squamous cell carcinoma was significantly higher than that in adenocarcinoma and small cell lung cancer (P0.01). (4) the sensitivity of single detection of HE4,CEA,NSE,Pro-GRP,CYFRA21-1 in the diagnosis of lung cancer was 63.2 and 45.6and 29.6and 14.4and 28.8respectively; The sensitivity of combined detection of five tumor markers in the diagnosis of lung cancer was increased to 90.4%. The immunohistochemical results showed that the positive rates of HE4 in adenocarcinoma, squamous cell carcinoma and small cell lung cancer were 78.5% and 10.5%, respectively. Conclusion 1 combined detection of serum HE4,CEA,NSE,Pro-GRP,CYFRA21-1 can greatly improve the sensitivity of diagnosis and differential diagnosis of lung cancer. 2 dynamic monitoring of serum HE4,CEA,NSE, in patients with lung cancer The changes of Pro-GRP and CYFRA21-1 levels can provide experimental basis for clinical evaluation of curative effect and prognosis. 3 Serum HE4 level can be used as a tumor marker for auxiliary diagnosis of lung cancer, which is worthy of clinical application.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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