【摘要】：背景在世界范圍內(nèi),肺癌是目前惡性腫瘤中發(fā)病率、死亡率均最高的一種惡性病,且隨著社會的發(fā)展其發(fā)病率仍呈上升趨勢。肺癌早期診斷率低且確診時已處于中晚期,五年生存率不足5%。目前肺癌仍以手術(shù)治療為主,結(jié)合化療放療等綜合療法。肺癌患者的手術(shù)療效是影響患者生存期的主要因素,患者術(shù)后是否出現(xiàn)腫瘤的轉(zhuǎn)移和復(fù)發(fā)尤其重要。目前已發(fā)現(xiàn)多種與肺癌相關(guān)的血清腫瘤標(biāo)志物,有文獻(xiàn)報道它們在腫瘤的預(yù)后分析及評價療效方面都起到了重要作用。目的動態(tài)監(jiān)測肺癌患者圍手術(shù)期血清四種腫瘤標(biāo)志物水平,并探討其在肺癌患者的整個治療過程中及預(yù)后監(jiān)測中的臨床意義。方法選取2014年5月至2015年5月期間我院呼吸內(nèi)科收治入院的肺癌患者58例為研究對象,設(shè)為肺癌組,其中男性38例,女性20例,年齡42~78歲,平均(53.7±6.8)歲。以上研究對象均經(jīng)支氣管鏡活檢確診為肺癌,其中早期(Ⅰ期)肺癌18例,中期(Ⅱ期)肺癌33例,Ⅲ期肺癌7例;按病程將其分為術(shù)前、術(shù)后1天、術(shù)后1周、術(shù)后1月及術(shù)后3月共五組;其中包括鱗癌29例,腺癌19例,腺樣囊性癌2例,腺鱗癌6例,腺泡細(xì)胞癌2例;其中分化程度為高分化6例,中分化31例,低分化21例。隨機(jī)選取同時間段來我院進(jìn)行體檢的健康人50例為對照組,體檢結(jié)果均正常。其中男性28例,女性22例,年齡40~66歲,平均(51.2±5.6)歲。肺癌組患者與對照組兩組的年齡、性別等一般資料均無顯著性差異,具有可比性。應(yīng)用化學(xué)發(fā)光免疫分析法分別檢測肺癌組患者在手術(shù)前、術(shù)后1天、術(shù)后1周、術(shù)后1月及術(shù)后3月等時間點(diǎn)的空腹血清CEA、CA19-9、CA125、CA153水平,相互進(jìn)行比較,并與對照組各血清腫瘤標(biāo)志物結(jié)果進(jìn)行比較。結(jié)果1.肺癌組患者在術(shù)前的平均空腹血清CEA、CA19-9、CA125、CA153水平均顯著高于對照組的四種腫瘤標(biāo)志物平均空腹血清水平,差異顯著具有統(tǒng)計學(xué)意義(P0.05);2.肺癌組患者在術(shù)后1天、1周、1月及3月的平均空腹血清CEA、CA19-9、CA125、CA153水平均顯著低于術(shù)前的四種腫瘤標(biāo)志物平均空腹血清水平,差異顯著具有統(tǒng)計學(xué)意義(P0.05);3.肺癌組患者在術(shù)后1月時的平均空腹血清CEA、CA19-9、CA125、CA153水平均高于其術(shù)后3月時的四種腫瘤標(biāo)志物平均空腹血清水平,但差異均不顯著,不具有統(tǒng)計學(xué)意義(P0.05)。4.肺癌組患者在術(shù)后1月、3月時的空腹血清CEA、CA19-9、CA125、CA153水平與正常組相比差異不具有顯著性(P0.05);5.肺癌組患者在不同臨床分期的術(shù)前平均血清CA19-9水平之間差異均不顯著,不具有統(tǒng)計學(xué)意義(P0.05);6.肺癌組患者在不同臨床分期的術(shù)前平均血清CEA、CA125、CA153水平之間的差異顯著,均具有統(tǒng)計學(xué)意義(P0.05);7.血清CEA、CA125、CA153水平與腫瘤分期呈正相關(guān),腫瘤分期越晚,肺癌患者的血清腫瘤標(biāo)志物水平越高;8.四種血清腫瘤標(biāo)志物CEA、CA19-9、CA125、CA153單項(xiàng)檢測診斷肺癌的敏感性分別為45.8%、26.5%、40.74%及10.4%,特異性分別為92.5%、90.42%、82.13%及97.8%,但其聯(lián)合檢測的敏感性則為93.06%,特異性為71.4%,效果明顯優(yōu)于單項(xiàng)檢測。提示四種血清腫瘤標(biāo)志物的聯(lián)合檢測可明顯提高檢測靈敏度。結(jié)論對肺癌患者的血清CEA、CA19-9、CA125、CA153水平進(jìn)行圍手術(shù)期動態(tài)監(jiān)測有助于臨床手術(shù)治療效果的評估。1.動態(tài)監(jiān)測圍手術(shù)期肺癌患者血清CEA、CA19-9、CA125、CA153的水平變化可以作為臨床監(jiān)測指標(biāo)評估手術(shù)療效;2.肺癌患者血清CEA、CA19-9、CA125、CA153聯(lián)合檢測優(yōu)于單項(xiàng)檢測,可用于肺癌的輔助診斷和預(yù)后的判斷。
[Abstract]:Background In the world, lung cancer is a kind of malignant disease with the highest morbidity and mortality in the current malignant tumor, and the incidence of lung cancer is still on the rise with the development of society. The early diagnosis rate of the lung cancer is low and the diagnosis is in the middle and late stage, and the five-year survival rate is less than 5%. At present, lung cancer is still the main surgical treatment, combined with the combination of chemotherapy and radiotherapy. The operation effect of the patients with lung cancer is the main factor that affects the survival of the patients. A variety of serum tumor markers associated with lung cancer have been found, and it has been reported that they play an important role in the analysis and evaluation of the prognosis of the tumor. Objective To monitor the level of serum four tumor markers in the perioperative period of patients with lung cancer, and to discuss the clinical significance of the four types of tumor markers in the whole treatment and prognosis of patients with lung cancer. Methods 58 patients with lung cancer admitted to our hospital from May 2014 to May 2015 were selected as the subjects of lung cancer, including 38 males and 20 females, aged 42 to 78 years, with an average of 53.7 (6.8) years. The above-mentioned subjects were diagnosed with lung cancer by bronchoscopy, including 18 cases of early stage (stage 鈪，

本文編號：2479076