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目的:评价肿瘤标志物角蛋白18、19(K18、K19)与癌胚抗原(CEA)联合应用对肺占位病变的良恶性鉴别诊断价值。方法:针对150例因肺占位在北京协和医院鉴别病变性质或肿瘤分期行FDG PET/CT显像的初诊患者,血清检测肿瘤标志物K18、K19和CEA。参照医学信息随访数据,将受检患者分为肿瘤组和非肿瘤组,比较K18、K19及CEA单独和联合在肺占位良恶性鉴别诊断中的临床意义。结果:①肿瘤组82例的K18、K19及CEA血清浓度均高于非肿瘤组68例(P<0.01);②晚期(III,IV期)肿瘤中的血清K18,K19,CEA均值都高于早期组(I,II期)(P<0.05)。③K18、K19和CEA对肺癌敏感性分别为25.6%、39%和47.6%,特异度分别为98.5%、83.8%和92.6%。K19和CEA联用,使肺癌检测敏感性明显提高,达65.9%。④K18、K19和CEA对临床I,II期肺癌敏感性分别为2.9%、29.4%和29.4%,K19与CEA联合应用对于临床I,II期肺癌的敏感性显著提高到47.1%。⑤K19对鳞癌的检测阳性率明显高于腺癌,而K18和CEA对腺癌的阳性检出率高于鳞癌。结论:肿瘤标志物角蛋白19针对肺鳞癌的检出率高;在肺占位的良恶性鉴别诊断中,与CEA联用,具有突出的互补性;而且,K19和CEA可共同提高早期肺癌的检测阳性率。
Objective: To evaluate the differential diagnostic value of tumor markers keratin 18, 19 (K18, K19) and carcinoembryonic antigen (CEA) in benign and malignant lesions of lung space. Methods: A total of 150 newly diagnosed FDG PET / CT scans were performed in Beijing Union Medical College Hospital for the identification of lesions or tumor staging. Serum samples were collected for the detection of tumor markers K18, K19 and CEA. According to the follow-up data of medical information, the subjects were divided into tumor group and non-tumor group, and to compare the clinical significance of K18, K19 and CEA alone and in combination in the differential diagnosis of benign and malignant lung emphysema. Results: ① The serum concentrations of K18, K19 and CEA in 82 patients in the tumor group were significantly higher than those in the non-tumor group (P <0.01); ② The serum K18, K19 and CEA in the advanced stage III and IV tumors were higher than those in the non-tumor group Early stage (stage I, II) (P <0.05). ③ The sensitivity of K18, K19 and CEA to lung cancer were 25.6%, 39% and 47.6% respectively, and the specificity were 98.5%, 83.8% and 92.6% respectively. K19 combined with CEA, lung cancer detection sensitivity was significantly increased, reaching 65.9%. The sensitivity of K18, K19 and CEA to stage I and II lung cancer was 2.9%, 29.4% and 29.4%, respectively. The sensitivity of combination of K19 and CEA for stage I and II lung cancer was significantly increased to 47.1%. ⑤ K19 positive rate of squamous cell carcinoma was significantly higher than that of adenocarcinoma, and K18 and CEA positive rate of adenocarcinoma was higher than squamous cell carcinoma. Conclusions: The detection rate of tumor marker keratin 19 in squamous cell carcinoma of the lung is high. In the differential diagnosis of benign and malignant lung lesions, CEA combined has outstanding complementarity. Moreover, K19 and CEA can jointly enhance the early stage of lung cancer The positive rate of detection.