血清HE4、VEGF、CYFRA21-1联合检测在非小细胞肺癌诊断中的意义及其与临床病理特征的关系

刘文楼; 王红梅; 秦晓冰; 赵阳; 韩正祥

doi:10.3969/j.issn.2096-3882.2020.09.001

血清HE4、VEGF、CYFRA21-1联合检测在非小细胞肺癌诊断中的意义及其与临床病理特征的关系

The significance of serum HE4, VEGF and CYFRA21-1 in the diagnosis of non-small cell lung cancer and their relationship with clinicopathological features

摘要

摘要: 目的探讨血清肿瘤标志物人附睾蛋白4(HE4)、血管内皮细胞生长因子(VEGF)、细胞角蛋白19片段(Cytokeratin-19-fragment,CYFRA21-1)联合检测在非小细胞肺癌(NSCLC)中的诊断价值及其水平与NSCLC临床病理特征的关系.方法采用酶联免疫吸附法(ELISA法)分别检测60例原发性NSCLC患者、55例肺良性病变或肺炎患者、55例健康体检者血清HE4、VEGF、CYFRA21-1的表达水平,并进行分析.结果 NSCLC组的血清HE4、VEGF、CYFRA21-1的水平均显著高于肺良性病变组和健康对照组(P<0.05).临床分期Ⅲ、Ⅳ期的患者血清HE4、VEGF、CYFRA21-1的水平显著高于Ⅰ、Ⅱ期的患者(P<0.05);有淋巴结转移的患者血清HE4、VEGF、CYFRA21-1水平显著高于无淋巴结转移的患者(P<0.05).血清中3种标志物的水平与患者年龄、性别、肿瘤T分期无显著相关性(P>0.05).血清HE4、VEGF水平与肺癌病理类型无关,而鳞状细胞癌患者血清CYFRA21-1的水平显著高于腺癌患者(P<0.05).经受试者工作特征曲线(ROC曲线)分析显示,血清HE4、VEGF、CYFRA21-1单项检测的曲线下面积(AUC)分别为0.803、0.857和0.751,而联合检测的AUC为0.895,高于单项检测.血清HE4、VEGF、CYFRA21-1检测对肺癌诊断的灵敏度为71.7％、77.4％、73.3％,特异度为80.8％、84.2％、75.8％.三者联合检测提高了肺癌诊断灵敏度,为91.7％,但特异度有所下降,为80.3％.结论血清中HE4、VEGF、CYFRA21-1水平在NSCLC患者中显著升高,与多项临床病理参数密切相关,且这种新的联合检测可提高NSCLC的诊断效率,有利于NSCLC的早期发现.

Abstract: ob＜x＞jective To investigate the diagnostic value of serum tumor markers levels HE4, VEGF and CYFRA21-1 in non-small cell lung cancer (NSCLC) and its correlation with the clinicopathological features of NSCLC. Methods The serum levels of HE4, VEGF and CYFRA21-1 ex＜x＞pression in 60 cases of NSCLC, 55 cases of benign lung diseases or pneumonia and 55 cases of healthy adults were detected by enzyme-li＜x＞nked immunosorbent assay (ELISA) and analyzed. Results The serum levels of HE4, VEGF and CYFRA21-1 in the NSCLC group were significantly higher than those in the benign and healthy control groups (p<0.05). The levels of serum HE4, VEGF and CYFRA21-1were significantly higher in stage III and IV patients than those in stage I and II (p<0.05). The levels of serum HE4, VEGF and CYFRA21-1 in patients with lymph node me＜x＞tastasis were significantly higher than those without lymph node me＜x＞tastasis (p<0.05). There was no significant correlation between serum levels of the three tumor markers and patients’ age, sex and tumor T stage. The levels of HE4 and VEGF were not correlated with the pathological type of lung cancer, while serum levels of CYFRA21-1 in patients with squamous cell carcinoma were significantly higher than those in patients with adenocarcinoma (p<0.05). ROC curve analysis showed that the AUC of HE4, VEGF and CYFRA21-1 were 0.803, 0.857 and 0.751, respectively, while the AUC of the combined detection of the three markers was 0.895 higher than that of the individual detection. The sensitivity of serum HE4, VEGF and CYFRA21-1 were 71.7%, 77.4% and 73.3%, respectively. The specificity were 80.8%, 84.2% and 75.8%, respectively. Combined detection of HE4, VEGF and CYFRA21-1 could improve the diagnostic sensitivity of lung cancer, which was 91.7%, but the specificity had decreased by 80.3%. Conclusion The ex＜x＞pression levels of serum HE4, VEGF and CYFRA21-1 were significantly increased in NSCLC, which was closely related to a number of clinicopathological parameters. Moreover, this new combined detection can improve the diagnostic efficiency and contribute to the early detection of NSCLC.

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