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目的探讨支气管肺泡灌洗液(BALF)中肿瘤标记物浓度检测在肺癌诊断、病理分型及临床分期中的应用价值。方法选择病理组织学和细胞学确诊的78例肺癌作为肺癌组,72例肺良性病变作为对照组,采用酶联免疫法,分别测定两组患者BALF及血清中CEA、可溶性细胞角蛋白19片段(CYFRA21-1)、NSE、鳞状上皮细胞癌相关抗原(SCC)的浓度。结果 (1)肺癌组血清中CEA、CYFRA21-1、NSE、SCC浓度明显高于对照组,两组比较差异显著(P<0.05);(2)肺癌组BALF中CEA、CYFRA21-1、NSE、SCC浓度明显高于对照组BALF中的浓度,两组比较差异显著(P<0.05);(3)肺癌组BALF中CEA、CYFRA21-1、NSE、SCC浓度明显高于血清中浓度,两组比较差异显著(P<0.05);(4)肺癌组患者血清及BALF中,CEA浓度在腺癌中最高,CYFRA21-1及SCC浓度在鳞癌中最高,NSE浓度在小细胞癌中最高,差异显著(P<0.05);(5)肺癌组BALF中CEA、CYFRA21-1、NSE、SCC的浓度在Ⅰ期与Ⅱ、Ⅲ、Ⅳ期肺癌之间比较差异均显著(P<0.05);Ⅱ、Ⅲ、Ⅳ期肺癌BALF中肿瘤标志物的水平较Ⅰ期患者显著升高(P<0.05)。结论 BALF中CEA、CYFRA21-1、NSE、SCC检测对肺癌的早期诊断优于血清。BALF中肿瘤标记物的检测对于推测病理类型、判断临床分期及预后有一定临床价值。
Objective To investigate the value of tumor marker concentration detection in bronchoalveolar lavage fluid (BALF) in the diagnosis, pathological classification and clinical stage of lung cancer. Methods Totally 78 lung cancer patients diagnosed by histopathology and cytology were selected as lung cancer group and 72 benign pulmonary disease group as control group. The levels of CEA and soluble cytokeratin 19 in BALF and serum were determined by enzyme-linked immunosorbent assay (ELISA) CYFRA21-1), NSE, and squamous cell carcinoma-associated antigen (SCC) concentrations. Results (1) The concentrations of CEA, CYFRA21-1, NSE and SCC in lung cancer group were significantly higher than those in control group (P <0.05). (2) The levels of CEA, CYFRA21-1, NSE, (3) The concentrations of CEA, CYFRA21-1, NSE and SCC in BALF in lung cancer group were significantly higher than those in serum, and the levels of SCC in BALF in lung cancer group were significantly higher than those in control group (P <0.05) (4) In the lung cancer group, the concentration of CEA in serum and BALF was highest in adenocarcinoma, CYFRA21-1 and SCC were the highest in squamous cell carcinoma, NSE was the highest in small cell carcinoma with significant difference (P <0.05) (P <0.05). (5) The concentrations of CEA, CYFRA21-1, NSE and SCC in BALF of lung cancer group were significantly different between stage Ⅰ and stage Ⅱ, Ⅲ and Ⅳ lung cancer (P <0.05) In stage Ⅳ, the level of tumor markers in BALF was significantly higher than that in stage Ⅰ (P <0.05). Conclusion The detection of CEA, CYFRA21-1, NSE and SCC in BALF is superior to serum in the early diagnosis of lung cancer. The detection of tumor markers in BALF has some clinical value for speculating pathological types and judging clinical stage and prognosis.