本文關(guān)鍵詞：腫瘤標(biāo)記物與肺間質(zhì)纖維化的相關(guān)性分析及臨床觀察　出處：《大連醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 特發(fā)性肺纖維化 腫瘤標(biāo)志物 肺功能

【摘要】：目的:本文旨在評估IPF患者血清腫瘤標(biāo)記物升高的水平,分析比較IPF與慢性阻塞性肺疾病繼發(fā)肺間質(zhì)改變、結(jié)締組織疾病相關(guān)性肺疾病之間血清腫瘤標(biāo)記物水平的差異以及探討IPF與腫瘤標(biāo)記物的相關(guān)關(guān)系,為臨床應(yīng)用提供參考依據(jù)。方法:本文回顧性分析了2011年1月至2015年12月于大連醫(yī)科大學(xué)附屬第一醫(yī)院以及大連醫(yī)科大學(xué)附屬第二醫(yī)院住院的101例IPF患者的血清CEA、CYFRA21-1、CA19-9水平,并連續(xù)性收集同期住院確診為肺腺癌(111例)、慢性阻塞性肺疾病繼發(fā)性間質(zhì)改變(COPD-ILD)(109例)、結(jié)締組織疾病相關(guān)性肺疾病(CTD-ILD)(94例)的患者以及健康體檢者(82例)的血清CEA、CYFRA21-1、CA19-9水平為對照組。所有納入病例均無心、肝、腎、胃腸等臟器腫瘤證據(jù)。除肺癌組患者,其他各組患者均無肺部腫瘤證據(jù)。回顧性收集IPF組患者的動脈血氣指標(biāo)及肺功能檢查指標(biāo)包括用力肺活量(FVC)、用力肺活量占預(yù)計值百分比(FVC%pred)、一氧化碳彌散量(DLCO)、一氧化碳彌散量占預(yù)計值百分比(DLCO%pred)的結(jié)果。檢測的血清CEA的參考值范圍為0-5.0 ng/ml,檢測的血清CYFRA211的參考值范圍為0-3.3ng/ml,檢測的血清CA19-9的參考值范圍為0-27U/ml,超過參考值上限為陽性,在正常參考值范圍內(nèi)為陰性。陽性率(%)=血清腫瘤標(biāo)記物水平超過參考上限的例數(shù)/總納入例數(shù)。采用秩和檢驗分析比較各組患者血清腫瘤標(biāo)記物水平的差異,并采用Spearman相關(guān)分析IPF患者血清腫瘤標(biāo)記物水平與動脈血氣及肺功能指標(biāo)的相關(guān)性。結(jié)果:1.IPF組患者血清CEA、CA19-9陽性檢出率分別為48.5%、51.2%,明顯高于健康體檢組、COPD-ILD組、CTD-ILD組;IPF組血清CYFRA21-1陽性檢出率為71.7%,明顯高于健康體檢組、COPD-ILD組,而與CTD-ILD無明顯差異。2.IPF組血清CEA、CA19-9水平分別為4.64(2.98,7.05)ng/ml、25.80(12.35,74.88)U/ml,明顯高于健康體檢組、COPD-ILD、CTD-ILD組;IPF組患者血清CYFRA21-1水平為4.49(3.21,6.09)ng/ml,明顯高于健康體檢組和COPD-ILD組,但與CTD-ILD組相比,差異無統(tǒng)計學(xué)意義。IPF組患者血清CEA水平明顯低于肺腺癌組。3.各組患者各腫瘤標(biāo)記物的最大值(95百分位數(shù),即有95%的患者其腫瘤標(biāo)記物在此數(shù)值范圍內(nèi)):IPF患者CEA、CYFRA21-1、CA19-9的最大值分別為12.54ng/ml、12.08ng/ml、251.85U/ml,COPD-ILD組CEA、CYFRA21-1、CA19-9的最大值分別為7.3ng/ml、5.84 ng/ml、34.7U/ml;CTD-ILD組CEA、CYFRA21-110.40ng/ml、CA19-9的最大值分別為10.95ng/ml、10.40ng/ml、140.0U/ml。4.將血清CEA水平根據(jù)血清濃度分為升高組和正常組,CEA升高組患者動脈血氣、FVC%pred、DLCO%pred水平均明顯低于正常組。5.血清CYFRA21-1水平與FVC%pred呈負(fù)相關(guān),血清CA19-9水平與DLCO%pred呈負(fù)相關(guān)性。結(jié)論:1.IPF患者血清腫瘤標(biāo)記物升高是一種常見現(xiàn)象,IPF患者CEA的參考范圍上限為12.54ng/ml,在臨床中,當(dāng)CEA水平小于12.54ng/ml時,可能與IPF本身特點相關(guān),當(dāng)CEA水平高于上述范圍時,更需高度警惕肺癌的發(fā)生。2.血清腫瘤標(biāo)記物在IPF與COPD-ILD、CTD-ILD之間存在水平的差異,其差異可能對于IPF與這兩種疾病鑒別有一定的提示作用。3.血清腫瘤標(biāo)記物水平或可反映IPF患者病情嚴(yán)重程度。
[Abstract]:Objective: to assess the serum tumor markers in patients with IPF increased the level of analysis and comparison of IPF and chronic obstructive pulmonary disease secondary to pulmonary interstitial changes, serum tumor marker level differences between lung disease of connective tissue disease related correlation and to explore the relationship between IPF and tumor markers, and provide reference for clinical application. Methods: This paper analyzed retrospectively from January 2011 to December 2015 in the First Affiliated Hospital of Dalian Medical University and the Second Affiliated Hospital of Dalian Medical University hospital in 101 cases of IPF patients with serum CEA, CYFRA21-1, CA19-9 level, and continuously collected in the same period were diagnosed as lung adenocarcinoma (111 cases), chronic obstructive pulmonary disease complicated with interstitial changes (COPD-ILD (109) cases of lung disease), connective tissue disease association (CTD-ILD) (94 cases) patients and healthy subjects (82 cases). The serum levels of CEA, CYFRA21-1, CA19-9 level control Group. All the cases of liver, kidney, heart, gastrointestinal and other organs. In addition to evidence of tumor in lung cancer group, the other groups of patients had no evidence of lung cancer were collected retrospectively. The patients in the IPF group index of arterial blood gas and lung function indexes including forced vital capacity (FVC), forced vital capacity (FVC%pred percentage of predicted value), diffusion capacity of carbon monoxide (DLCO), carbon monoxide diffusion volume percentage of predicted value (DLCO%pred). The results of serum CEA detection of the reference ranges for 0-5.0 ng/ml, serum CYFRA211 detection reference range for 0-3.3ng/ml, serum CA19-9 detection of the reference range of 0-27U/ml, more than the maximum reference value was positive. In the normal reference range was negative. The positive rate (%) = D / serum tumor marker levels exceed the reference limit the total enrollment. Rank sum test was used to analyze the group compared with the serum levels of tumor markers The difference, and the correlation of Spearman correlation analysis of serum tumor markers in patients with IPF levels and arterial blood gas and lung function index. Results: in 1.IPF group, serum CEA, CA19-9 positive rates were 48.5%, 51.2%, significantly higher than the healthy group, COPD-ILD group, CTD-ILD group; IPF group serum CYFRA21-1 positive rate was 71.7%. Was significantly higher than healthy group, COPD-ILD group and.2.IPF group have no significant differences in serum CEA and CTD-ILD, CA19-9 levels were 4.64 (2.98,7.05) ng/ml, 25.80 (12.35,74.88) U/ml, was significantly higher than healthy group, COPD-ILD group, CTD-ILD group; CYFRA21-1 level of serum IPF was 4.49 (3.21,6.09) ng/ml, was significantly higher than healthy group and COPD-ILD group, but compared with the CTD-ILD group, the maximum value was no significant difference between.IPF group of serum CEA levels in patients with lung adenocarcinoma group.3. group of patients with different tumor markers were significantly lower than the 9 thousand and 500 percentile (i.e. There were 95% patients with tumor markers in this range of values): IPF patients with CEA, CYFRA21-1, the maximum value of CA19-9 were 12.54ng/ml, 12.08ng/ml, 251.85U/ml, COPD-ILD group CEA, CYFRA21-1, the maximum value of CA19-9 were 7.3ng/ml, 5.84 ng/ml, 34.7U/ml; group CTD-ILD CEA, CYFRA21-110.40ng/ml CA19-9, the maximum value was 10.95ng/ml 10.40ng/ml, 140.0U/ml.4., CEA serum levels according to serum concentrations were divided into increased group and normal group, CEA group were elevated arterial blood gas, FVC%pred, DLCO%pred were significantly lower than normal group.5. was negatively correlated with the level of serum CYFRA21-1 and FVC%pred, there was a negative correlation between the serum level of CA19-9 and DLCO%pred. Conclusion: 1.IPF serum tumor markers in the patients with elevated a common phenomenon, the upper limit of the reference range of IPF CEA in patients with 12.54ng/ml in clinical practice, when the CEA level is less than 12.54ng/ml, may be associated with the IPF itself, when CEA The level is higher than the range, more need to be highly vigilant in lung cancer.2. serum tumor markers in IPF and COPD-ILD, there are differences in the level of CTD-ILD, the difference may be due to the IPF and identify the two diseases with serum tumor markers of.3. indicate a certain level may reflect the severity of IPF.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R734.2;R563

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本文編號：1358107