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目的:探讨肺癌患者肿瘤标记物在早期诊断方法中采用联合检测提高诊断率的依据和监测病情变化的价值。方法:对293例肺癌患者年龄38～81岁,男女比例3:1,均来自2002年12月至2006年11月我院门诊和住院患者,进行NSE、D-二聚体、CEA、IL-6R水平的检测,将293例患者分为:早期肺癌组98例,晚期肺癌组195例,非小细胞肺癌(non-small cell lungcancer,NSCLC)组202例,小细胞肺癌(small cell lung cancer,SCLC)组91例,患者治疗前138例,治疗后155例,健康查体者选300例作为正常组作对照,年龄35至80岁,男女比例3:1,采用酶联免疫法对293例肺癌患者的血标本进行神经元烯醇化酶(NSE)、癌胚抗原(CEA)、白介素-6受体(IL-6R)、D-二聚体(D-Dimer)四项含量检测。结果:早期肺癌组CEA、NSE、IL-6R含量均高于健康对照组(P<0.01),而D-Dimer在早期肺癌患者中与健康对照组比较差异不显著(P>0.05),晚期肺癌组CEA、NSE、IL-6R、D-Dimer的含量均高于早期肺癌组(P<0.01),NSCLC组CEA、IL-6R、D-Dimer的含量均高于SCLC组(P<0.01)而NSE小于SCLC组,治疗前CEA、NSE、IL-6R的含量均高于治疗后(P<0.01)。阳性诊断率分别为四项同时检测81.6%、NSE、CEA、IL-6R三项检测78.2%、NSE、CEA两项检测61.8%、NSE-项检测48.5%。结论:CEA、NSE、IL-6R、D-Dimer四项联合检测比单项检测阳性诊断率高,且对肺癌分型诊断有一定的价值,特别对无症状早期肺癌诊断和肺癌的病情观察有很高的临床价值。
OBJECTIVE: To investigate the basis of the combined detection of tumor markers in early diagnosis of lung cancer to improve the diagnosis rate and to monitor the value of the disease changes. Methods: A total of 293 lung cancer patients aged 38-81 years and male to female ratio of 3: 1, all from outpatients and inpatients in our hospital from December 2002 to November 2006 were enrolled in this study. NSE, D-dimer, CEA, IL- 6R levels in 293 patients were divided into: 98 cases of early lung cancer group, 195 cases of advanced lung cancer group, 202 cases of non-small cell lung cancer (NSCLC) group, small cell lung cancer (small cell lung cancer, SCLC group, 91 cases, 138 cases before treatment, after treatment, 155 cases, 300 healthy subjects were selected as the normal control group, aged 35 to 80 years old, male to female ratio of 3: 1, using enzyme-linked immunosorbent assay 293 cases Blood samples from patients with lung cancer were tested for four levels of neuron enolase (NSE), CEA, IL-6R and D-Dimer. Results: The levels of CEA, NSE and IL-6R in early lung cancer group were significantly higher than those in healthy control group (P <0.01), while D-Dimer was not significantly different from that in healthy control group (P> 0.05) The levels of CEA, NSE, IL-6R and D-Dimer in the NSCLC group were significantly higher than those in the early lung cancer group (P <0.01). The levels of CEA, IL-6R and D-Dimer in the NSCLC group were higher than those in the SCLC group NSE was lower than that of SCLC group, and the levels of CEA, NSE and IL-6R before treatment were higher than those before treatment (P <0.01). The positive diagnostic rates were 81.6% for four simultaneous tests, 78.2% for NSE, CEA and IL-6R, 61.8% for NSE and CEA, and 48.5% for NSE-test. CONCLUSIONS: The four combined tests of CEA, NSE, IL-6R and D-Dimer have a higher diagnostic rate than single test, and they are valuable for the diagnosis of lung cancer. In particular, the diagnosis of asymptomatic early-stage lung cancer and the observation of lung cancer are very significant High clinical value.