【摘要】：目的檢測(cè)肺癌患者HE4、CEA、NSE、Pro-GRP和CYFRA21-1的表達(dá)水平,探討其聯(lián)合檢測(cè)在肺癌診斷中的臨床意義。方法選取2015年2月至2016年4月,在益都中心醫(yī)院呼吸科入院診治的125例肺癌患者作為研究對(duì)象,即肺癌組(包括腺癌65例,鱗癌40例,小細(xì)胞肺癌20例);同期選取40例肺部良性疾病者作為肺部良性疾病組和50健康體檢者作為對(duì)照組。采用電化學(xué)發(fā)光法測(cè)定血清HE4、CEA、NSE、Pro-GRP和CYFRA21-1濃度水平,比較各組檢測(cè)指標(biāo)的水平差異及相關(guān)性;采用免疫組織化學(xué)法檢測(cè)HE4在組織中的表達(dá),并進(jìn)行相關(guān)的統(tǒng)計(jì)學(xué)分析。結(jié)果①肺癌組患者血清HE4、CEA、NSE、Pro-GRP、CYFRA21-1水平顯著增高,與肺部良性疾病組及對(duì)照組比較均有統(tǒng)計(jì)學(xué)差異(P0.01);但肺部良性疾病組與對(duì)照組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);②肺癌組患者治療后血清中HE4、CEA、NSE、Pro-GRP、CYFRA21-1濃度水平較治療前明顯降低,治療前、后各項(xiàng)指標(biāo)比較均有統(tǒng)計(jì)學(xué)差異(P0.01),但CEA、NSE、Pro-GRP仍高于對(duì)照組,與對(duì)照組比較有統(tǒng)計(jì)學(xué)差異(P0.05);③腺癌患者血清中HE4和CEA濃度水平明顯高于鱗癌和小細(xì)胞肺癌(P0.01),小細(xì)胞肺癌患者血清中NSE和Pro-GRP濃度水平明顯高于腺癌和鱗癌(P0.01),鱗癌患者血清CYFRA21-1濃度水平明顯高于腺癌和小細(xì)胞肺癌(P0.01);④單一檢測(cè)HE4、CEA、NSE、Pro-GRP、CYFRA21-1診斷肺癌的敏感性分別為63.2%、45.6%、29.6%、14.4%、28.8%;而聯(lián)合檢測(cè)5項(xiàng)腫瘤標(biāo)志物診斷肺癌的敏感度可提高為90.4%;⑤免疫組織化學(xué)結(jié)果顯示,HE4在腺癌、鱗癌和小細(xì)胞肺癌表達(dá)陽(yáng)性率分別是78.5%、55%和10%。結(jié)論①聯(lián)合檢測(cè)血清HE4、CEA、NSE、Pro-GRP、CYFRA21-1可大大提高肺癌診斷和鑒別診斷的敏感率。②動(dòng)態(tài)監(jiān)測(cè)肺癌患者血清HE4、CEA、NSE、Pro-GRP和CYFRA21-1水平變化可為臨床判斷療效和評(píng)估預(yù)后提供實(shí)驗(yàn)依據(jù)。③血清HE4水平可以作為輔助診斷肺癌的腫瘤標(biāo)記物,值得臨床推廣應(yīng)用。
[Abstract]:Objective to detect the expression of HE4,CEA,NSE,Pro-GRP and CYFRA21-1 in patients with lung cancer and to explore the clinical significance of combined detection in the diagnosis of lung cancer. Methods from February 2015 to April 2016, 125 patients with lung cancer (including 65 cases of adenocarcinoma, 40 cases of squamous cell carcinoma and 20 cases of small cell lung cancer) who were admitted to the Department of Respiratory Medicine of Yidu Central Hospital were selected as the study subjects. At the same time, 40 patients with benign pulmonary diseases were selected as control group and 50 healthy persons as control group. The levels of serum HE4,CEA,NSE,Pro-GRP and CYFRA21-1 were measured by electrochemiluminescence (ECL), and the difference and correlation of serum HE4,CEA,NSE,Pro-GRP and CYFRA21-1 in each group were compared. Immunohistochemical method was used to detect the expression of HE4 in tissues. Results 1 the serum HE4,CEA,NSE,Pro-GRP,CYFRA21-1 level in lung cancer group was significantly higher than that in benign pulmonary disease group and control group (P0.01). But there was no significant difference between the benign pulmonary disease group and the control group (P0.05). (2) the serum HE4,CEA,NSE,Pro-GRP,CYFRA21-1 level in lung cancer group was significantly lower than that before treatment (P0.01), but CEA,NSE,Pro-GRP was still higher than that in control group (P0.01). Compared with the control group, there was statistical difference (P0.05). 3 the levels of HE4 and CEA in patients with adenocarcinoma were significantly higher than those in squamous cell carcinoma and small cell lung cancer (P0.01), and the levels of NSE and Pro-GRP in serum of patients with small cell lung cancer were significantly higher than those of adenocarcinoma and squamous cell carcinoma (P0.01). The level of serum CYFRA21-1 in patients with squamous cell carcinoma was significantly higher than that in adenocarcinoma and small cell lung cancer (P0.01). (4) the sensitivity of single detection of HE4,CEA,NSE,Pro-GRP,CYFRA21-1 in the diagnosis of lung cancer was 63.2 and 45.6and 29.6and 14.4and 28.8respectively; The sensitivity of combined detection of five tumor markers in the diagnosis of lung cancer was increased to 90.4%. The immunohistochemical results showed that the positive rates of HE4 in adenocarcinoma, squamous cell carcinoma and small cell lung cancer were 78.5% and 10.5%, respectively. Conclusion 1 combined detection of serum HE4,CEA,NSE,Pro-GRP,CYFRA21-1 can greatly improve the sensitivity of diagnosis and differential diagnosis of lung cancer. 2 dynamic monitoring of serum HE4,CEA,NSE, in patients with lung cancer The changes of Pro-GRP and CYFRA21-1 levels can provide experimental basis for clinical evaluation of curative effect and prognosis. 3 Serum HE4 level can be used as a tumor marker for auxiliary diagnosis of lung cancer, which is worthy of clinical application.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R734.2

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