本文關(guān)鍵詞：常見肺癌血清腫瘤標(biāo)志物在具有肺癌高危因素患者中的臨床意義　出處：《北京協(xié)和醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 血清腫瘤標(biāo)志物 小細(xì)胞肺癌 非小細(xì)胞肺癌 診斷價值

【摘要】：目的：探索常用肺癌相關(guān)血清學(xué)腫瘤標(biāo)志物與肺癌診斷、病理類型、臨床分期及表皮生長因子受體基因突變情況的關(guān)系。探索一組具有高敏感性和高特異性的腫瘤標(biāo)志物譜。方法：根據(jù)入組標(biāo)準(zhǔn)選取2013年1月至2014年10月期間就診于北京協(xié)和醫(yī)院的患者,分別納入肺癌組和良性肺疾病組。采集受試者10ml血液標(biāo)本,檢測血清ProGRP、CEA、SCC-Ag和Cyfra21-1四種腫瘤標(biāo)志物水平,按檢測制造商說明將血清ProGRP65pg/ml、SCC-Ag1.5ng/ml、Cyfra21-12.08ng/ml及 CEA5ng/ml視為高于正常水平。對不同腫瘤標(biāo)記物計算診斷肺癌的敏感性、特異性、陽性預(yù)測值和陰性預(yù)測值。采用非參數(shù)秩和檢驗(兩樣本采用Mann-WhitneyU檢驗,多樣本采用Kruskal-Wallis H檢驗)比較不同亞類的研究對象腫瘤標(biāo)志物指標(biāo)分布情況。通過受試者工作特征曲線(receiver operating characteristic,ROC)比較不同腫瘤標(biāo)記物的診斷準(zhǔn)確性。在所有統(tǒng)計學(xué)分析中,設(shè)定當(dāng)p0.05時,具有統(tǒng)計學(xué)意義。結(jié)果：納入受試者221名,包括113名肺癌患者、108名肺良性疾病。獨立樣本Kruskal-Wallis H檢驗證實血清ProGRP、SCC-Ag、Cyfra21-1肺癌組表達(dá)水平高于肺良性疾病組,有統(tǒng)計學(xué)意義(p=0.004, p=0.001, p=0.005)。單項檢測時,Cyfra21-1診斷肺癌的敏感性56.6%,特異性63.3%, AUC-ROC為0.658;腫瘤標(biāo)志物譜(聯(lián)合ProGRP?SCC-Ag、Cyfra21-1和CEA)診斷肺癌的敏感性為72.9%,特異性為75%,AUC-ROC為0.739。在肺癌組中,SCC-Ag(1.5ng/ml)診斷肺鱗癌的敏感性為87.9%,特異性為91%,AUC-ROC為0.968；ProGRP(65pg/ml)診斷小細(xì)胞肺癌的敏感性為93.8%,特異性為99.0%,AUC-ROC 0.999.在肺癌患者中,晚期(Ⅲ+Ⅳ期)肺癌患者血清SCC-Ag、Cyfra21-1、CEA表達(dá)高于早期(Ⅰ+Ⅱ期)肺癌患者,有統(tǒng)計學(xué)意義(P=0.022,P=0.000,P=0.043)。在小細(xì)胞肺癌患者中,ED-SCLC患者血清ProGRP表達(dá)水平高于LD-SCLC患者(P=0.000)。EGFR基因組分析發(fā)現(xiàn),CEA水平與EGFR突變型具有統(tǒng)計學(xué)相關(guān)性(p=0.000)。結(jié)論：研究結(jié)果表明,在具有肺癌高危因素患者中,以ProGRP、SCC-Ag、 Cyfra21-1及CEA組成的腫瘤標(biāo)志物譜診斷肺癌敏感性有所提高,具有一定的輔助診斷價值。血清SCC-Ag診斷肺鱗癌、血清ProGRP診斷小細(xì)胞肺癌均具有較好的敏感性和特異性。四項腫瘤標(biāo)記物與臨床分期有相關(guān)性。血清CEA升高的肺腺癌是EGFR突變型患者的臨床特點之一。
[Abstract]:Objective: to explore the relationship between serological tumor markers of lung cancer and the diagnosis and pathological types of lung cancer. The relationship between clinical stage and epidermal growth factor receptor gene mutation. To explore a group of highly sensitive and specific tumor markers. Methods:. According to the criteria selected from January 2013 to October 2014 in Beijing Union Hospital patients. 10 ml blood samples were collected from patients with lung cancer and benign lung diseases respectively, and the serum levels of four tumor markers (ProGRP CEA SCC-Ag and Cyfra21-1) were detected. The serum ProGRP 65pg / ml SCC-Ag 1.5ng / ml was measured according to the manufacturer's instructions. Cyfra21-12.08ng/ml and CEA5ng/ml were considered to be higher than the normal level. The sensitivity and specificity of different tumor markers in the diagnosis of lung cancer were calculated. Positive predictive value and negative predictive value. Nonparametric rank sum test (Mann-WhitneyU test for two samples) was used. Kruskal-Wallis H test was used to compare the distribution of tumor markers in different subgroups. Receiver operating characteristic. Roc) compared the diagnostic accuracy of different tumor markers. In all statistical analyses, the setting of p0.05 was statistically significant. Results: 221 subjects were included. There were 113 patients with lung cancer and 108 patients with benign lung diseases. Serum ProGRPg SCC-Ag was confirmed by independent Kruskal-Wallis H test. The expression level of Cyfra21-1 in lung cancer group was higher than that in benign lung disease group. The sensitivity of Cyfra21-1 in the diagnosis of lung cancer was 56. 6%, the specificity was 63. 3%, and the AUC-ROC was 0. 658; Tumor marker spectrum (combined with ProGRP? The sensitivity of SCC-AgAg-Cyfra21-1 and CEA in the diagnosis of lung cancer was 72.9, and the specificity was 75AUC-ROC (0.739) in lung cancer group. The sensitivity and specificity of SCC-AgN 1.5ng / ml in the diagnosis of lung squamous cell carcinoma were 87.9 and 91AUC-ROC 0.368, respectively. The sensitivity and specificity of ProGRPU 65pg / ml in the diagnosis of small cell lung cancer were 93.8 and 99.0, respectively. The expression of CEA in serum of patients with advanced stage (鈪，

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