血清七种自身抗体与传统肿瘤标志物在肺癌诊断中的价值分析-东南大学学报医学版

血清七种自身抗体与传统肿瘤标志物在肺癌诊断中的价值分析

单位：1. 南京大学医学院附属泰康仙林鼓楼医院, 江苏南京 210046;
2. 南京大学医学院附属东部战区总医院, 江苏南京 210002

分类号：R734.2

出版年·卷·期（页码）：2022·41·第四期（505-510）

摘要：

目的：比较血清7种自身抗体和13种传统肿瘤标志物在肺癌患者临床诊断中的价值。方法：采用ELISA法检测7种自身抗体；采用化学发光法检测糖类抗原125（CA125）、鳞癌抗原（SCC）、糖类抗原153（CA153）、总前列腺特异性抗原（TPSA）、游离前列腺特异性抗原（FPSA）、糖类抗原50（CA50）、糖类抗原242（CA242）、甲胎蛋白（AFP）、癌胚抗原（CEA）；采用电化学发光法检测糖类抗原199（CA199）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA211）、糖类抗原724（CA724）。共收集105例临床干预前肺癌高危患者血清，后经病理确认，其中良性肺结节27例，肺癌74例，排除无病理结果4例。比较7种自身抗体和13种传统肿瘤标志物在两组患者中的表达差异，并分析这些血清学指标与肺癌最大直径的相关性，通过绘制ROC曲线比较7种自身抗体和13种传统肿瘤标志物单独及联合检测在肺癌中的诊断效能，并计算其敏感性、特异性、阴性预测值、阳性预测值。结果：与良性肺结节组比较，肺癌组7种自身抗体中的5种（p53、SOX2、GAGE7、MAGEA1、CAGE）明显升高（P<0.01），而13种传统肿瘤标志物中则有3种（CA125、SCC、CEA）明显升高（P<0.05）。7种自身抗体中的SOX2与肿瘤最大直径相关（r=0.25，P<0.05），传统肿瘤标志物中CA199、CA50、CYFRA211、CA153、CA125、NSE、CA242均与肿瘤最大直径相关（r分别为0.41、0.40、0.39、0.35、0.23、0.24、0.27，P<0.05）。7种自身抗体与传统肿瘤标志物联合检测肺癌的ROC曲线下面积（AUC）为0.876，大于7种自身抗体的0.777和传统肿瘤标志物的0.726。7种自身抗体检测肺癌的特异性和阳性预测值最高，分别为85.19%、90.00%，7种自身抗体与传统肿瘤标志物联合检测可提高敏感性至81.08%。结论：血清7种自身抗体检测可有效提高肺癌辅助诊断水平，传统肿瘤标志物则适用于疗效监测，二者联合对诊断效能提高更有帮助。

Objective: To investigate the clinical diagnostic value of seven serum autoantibodies and 13 kinds of traditional tumor markers in patients with lung cancer.Methods: Seven serum autoantibodies were detected by ELISA. CA125, SCC, CA153, TPSA, FPSA, CA50, CA242, AFP, CEA were detected by Chemiluminescence. Electrochemical luminescence method was used to detect CA199, NSE, CYFRA211, CA724. The serums of 105 subjects with high risk of lung cancer were collected before clinical intervention and confirmed by pathology, among which 27 with benign pulmonary nodules, 74 with lung cancers, and 4 were excluded on account of deficiency of pathological. The expression of seven autoantibodies and 13 kinds of traditional tumor markers were compared in the two groups and the correlation between the serological indexes and the largest diameter of the lung cancer was analyzed. Lung cancer diagnosis efficiency was assessed solely and synthetically by comparing areas under ROC curve(AUC) in seven autoantibodies and 13 kinds of traditional tumor markers detection, and the sensitivity, specificity, negative predictive value, positive predictive value were calculated. Results: Five of the seven autoantibodies(p53, SOX2, GAGE7, MAGEA1, CAGE) in the lung cancer group were significantly increased(P<0.01), while three of the 13 traditional tumor markers(CA125, SCC, CEA) distinctly increased(P<0.05). SOX2 was slightly correlated with the largest tumor diameter(r=0.25, P<0.05), CA199, CA50, CYFRA211, CA153, CA125, NSE, CA242 were correlated with the largest tumor diameter(r=0.41,0.40,0.39,0.35,0.23,0.24,0.27, P<0.05). The AUC of seven autoantibodies combined with traditional tumor markers to detect lung cancer is 0.876, which is greater than 0.777 of seven autoantibodies and 0.726 of traditional tumor markers. The specificity and positive predictive value of seven autoantibodies to detect lung cancer were highest,which were 85.19% and 90.00%, respectively. The combined detection of seven autoantibodies and traditional tumor markers can improve the sensitivity to 81.08%. Conclusion: The detection of seven serum autoantibodies is more useful to diagnose the early stage lung cancer, and traditional tumor markers are suitable for monitoring the treatment effect, but the combination of the two is more helpful for improving the diagnostic efficiency.

参考文献：

[1] 钱桂生.肺癌不同病理类型发病率的变化情况及原因[J].中华肺部疾病杂志(电子版), 2011, 4(1):1-6.
[2] 中华人民共和国卫生委员会.原发性肺癌诊疗规范[J].肿瘤综合治疗电子杂志, 2019, 5(3):100-120.
[3] 王水莲, 杨芳.肺癌早期筛查方法的研究进展[J].癌症进展, 2018, 16(15):1836-1840.
[4] ZHAO W, YU H, HAN Z, et al.Clinical significance of joint detection of serum CEA, SCCA, and bFGF in the diagnosis of lung cancer[J].Int J Clin Exp Pathol, 2015, 8:9506-9511.
[5] XU C, HAO K, YU L, et al.Serum interleukin-17 as a diagnostic and prognostic marker for non-small cell lung cancer[J].Biomarkers, 2014, 19:287-290.
[6] 贾金芳, 黄静, 朱晓莉.肿瘤相关自身抗体对恶性肺结节的诊断价值[J].中国肿瘤临床, 2020, 47(6):271-276.
[7] 高成磊, 宋海燕, 王燕, 等.肺癌7种自身抗体的表达变化及临床意义[J].国际检验医学杂志, 2020, 41(10):1266-1270.
[8] LI Y, KARJALAINEN A, KOSKINEN H, et al.p53 autoantibodies predict subsequent development of cancer[J].Int J Cancer, 2005, 114(1):157-160.
[9] CHAPMAN C J, MURRAY A, MCELVEEN J E, et al.Autoantibodies in lung cancer:possibilities for early detection and subsequent cure[J].Thorax, 2008, 63(3):228-233.
[10] EDWARDS B K, WARD E, KOHLER B A, et al.Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions(risk factors, screening, and treatment) to reduce future rates[J].Cancer, 2010, 116(3):544-573.
[11] HUMPHREY L L, TEUTSCH S, JOHNSON M.Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography:an update for the U.S.Preventive Services Task Force[J].Ann Intern Med, 2004, 140(9):740-753.
[12] MULEY T, DIENEMANN H, EBERT W.CYFRA 21-1 and CEA are independent prognostic factors in 153 operated stage I NSCLC patients[J].Anticancer Res, 2004, 24(3b):1953-1956.
[13] JETT J, HEALEY G, MACDONALD I, et al.Determination of the detection lead time for autoantibody biomarkers in early stage lung cancer using the UKCTOCS Cohort[J].Thoracic Oncology, 2017, 12(11):2170.
[14] REN S, ZHANG S, JIANG T, et al.Early detection of lung cancer by using an antoantibody panel in Chinese population[J].Oncoimmunol, 2018, 7(2):e1384108.
[15] 卢仁泉, 陈苗苗, 郭林.肿瘤标志物联合检测及评分模型在肿瘤诊疗中的应用[J].中华检验医学杂志, 2018, 41(3):180-184.
[16] 张红军, 房延凤, 刘伟, 等.肺癌患者自身抗体与肿瘤标志物相关性分析[J].中华肺部疾病杂志(电子版), 2017, 10(2):141-145.

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