标题：血清CYFRA21-1、CEA、SCC、HE4、ProGRP对肺癌早期诊断及病理类型鉴别的临床价值

      作者：张涛 1，张波 2，张学伟 1，周莹 1    1.安康市中心医院检验科，陕西 安康 725000；2.安康市中医医院检验科，陕西 安康 725000

      卷次： 2023年34卷9期

      【摘要】 目的 探究肿瘤标志物血清细胞角蛋白 19片段(CYFRA21-1)、癌胚抗原(CEA)、鳞状细胞癌抗原(SCC)、人附睾蛋白4 (HE4)、胃泌素释放肽前体(ProGRP)对肺癌早期诊断及病理类型鉴别的临床价值。方法 选取2021年2月至2022年2月安康市中心医院收治的280例肺癌早期患者作为肺癌组，同期收治的100例肺部良性疾病患者作为良性对照组，比较两组患者的血清CYFRA21-1、CEA、SCC、HE4及ProGRP水平，采用受试者工作特征曲线(ROC)分析血清CYFRA21-1、CEA、SCC、HE4、ProGRP以及联合检测对肺癌早期诊断的临床价值，并根据肺癌组患者的病理分型结果比较非小细胞肺癌(NSCLC)与小细胞肺癌(SCLC)患者的血清CYFRA21-1、CEA、SCC、HE4及ProGRP水平。结果 肺癌组患者的血清CYFRA21-1、CEA、SCC、HE4及 ProGRP水平分别为(2.04±1.87) ng/mL、(3.08±0.82) ng/mL、(4.51±1.54) ng/mL、(60.14±15.88) pmol/L、(61.27±19.34) μg/L，明显高于良性对照组的(1.15±0.43) ng/mL、(2.54±0.71) ng/mL、(3.09±1.68) ng/mL、(45.14±17.56) pmol/L、(50.14±18.73) μg/L，差异均有统计学意义(P<0.05)；经ROC分析结果显示，血清CYFRA21-1诊断肺癌早期的最佳截断值为1.830 ng/mL，CEA为2.856 ng/mL，SCC为3.140 ng/mL，HE4为50.340 pmol/L，ProGRP为57.605 μg/L，5项指标联合诊断肺癌早期的AUC及敏感度达到0.901、89.30%，均高于单一指标诊断，差异有统计学意义(P<0.05)；SCLC组患者的ProGRP水平明显高于NSCLC组，差异有统计学意义(P<0.05)，而两组患者的CYFRA21-1、CEA、SCC及HE4水平比较差异均无统计学意义(P>0.05)；腺癌组患者的SCC为(5.50±2.73) ng/mL，明显高于鳞癌组的(1.42±0.05) ng/mL，差异有统计学意义(P<0.05)，而两组患者的CYFRA21-1、CEA、HE4及ProGRP水平比较差异均无统计学意义(P>0.05)。结论 与肺部良性疾病患者比较，肺癌早期患者血清CYFRA21-1、CEA、SCC、HE4及ProGRP水平更高，且其联合检测诊断早期肺癌的临床价值高，血清ProGRP鉴别NSCLC与SCLC，血清SCC鉴别腺癌与鳞癌均有一定价值，建议临床密切监测。
      【关键词】 肺癌；血清细胞角蛋白19片段；癌胚抗原；鳞状细胞癌抗原；人附睾蛋白4；胃泌素释放肽前体；病理类型；鉴别价值
      【中图分类号】 R734.2 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1281—05

Clinical value of serum CYFRA21-1, CEA, SCC, HE4, and ProGRP in the diagnosis and pathological typing ofearly lung cancer.
ZHANG Tao 1, ZHANG Bo 2, ZHANG Xue-wei 1, ZHOU Ying 1. 1. Department of Laboratory Medicine,Ankang Central Hospital, Ankang 725000, Shaanxi, CHINA; 2. Department of Laboratory Medicine, Ankang Hospital ofTraditional Chinese Medicine, Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To investigate the clinical value of serum cytokeratin 19 fragment (CYFRA21-1), car-cinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), human epididymisprotein 4 (HE4) and progas-trin-releasing peptide (ProGRP) in the diagnosis and pathological typing of early lung cancer. Methods A total of 280patients with early lung cancer (lung cancer group) and 100 patients with benign lung diseases (benign control group) whowere admitted to Ankang Central Hospital from February 2021 to February 2022 were enrolled in this research. Serum CY-FRA21-1, CEA, SCC, HE4, and ProGRP levels were compared between the two groups of patients. The receiver operat-ing characteristic (ROC) curve was used to analyze the clinical value of serum CYFRA21-1, CEA, SCC, HE4, ProGRPalone and in combination in the diagnosis of early lung cancer. According to the pathological typing results of lung can-cer group, serum CYFRA21-1, CEA, SCC, HE4, and ProGRP levels were compared between patients with non-smallcell lung cancer (NSCLC) and patients with small cell lung cancer (SCLC). Results Serum CYFRA21-1, CEA, SCC,HE4, and ProGRP levels in the lung cancer group were (2.04±1.87) ng/mL, (3.08±0.82) ng/mL, (4.51±1.54) ng/mL,(60.14±15.88) pmol/L, and (61.27±19.34) μg/L, significantly higher than (1.15±0.43) ng/mL, (2.54±0.71) ng/mL, (3.09±1.68) ng/mL, (45.14±17.56) pmol/L, and (50.14±18.73) μg/L in the benign control group (P<0.05). ROC curve analysisresults showed that the optimal cut-off values of serum CYFRA21-1, CEA, SCC, HE4, and ProGRP to diagnose earlylung cancer were 1.830 ng/mL, 2.856 ng/mL, 3.140 ng/mL, 50.340 pmol/L, and 57.605 μg/L, respectively. The AUC andsensitivity of the 5 indicators in combination in the diagnosis of early lung cancer (0.901 and 89.30%) were significantlyhigher than those of single diagnosis (P<0.05). The level of ProGRP in patients with SCLC was significantly higher thanthat in patients with NSCLC, and the difference was statistically significant (P<0.05). The levels of CYFRA21-1, CEA,SCC, and HE4 showed no statistically significant difference between the two groups (P>0.05). For patients withNSCLC, the level of SCC in patients with adenocarcinoma was significantly higher than that in patients with squamouscell carcinoma: (5.50±2.73) ng/mL, (1.42±0.05) ng/mL, P<0.05. There was no statistically significant difference in thelevels of CYFRA21-1, CEA, HE4, and ProGRP (P<0.05). Conclusion Serum CYFRA21-1, CEA, SCC, HE4, andProGRP levels in patients with early lung cancer are higher than those in patients with benign lung diseases. Combina-tion of the 5 indicators is more helpful for the diagnosis of early lung cancer. Serum ProGRP is helpful for distinguishingNSCLC from SCLC, and serum SCC is helpful for distinguishing adenocarcinoma from squamous cell carcinoma. Clini-cally, close monitoring of these indicators is recommended.
      【Key words】 Lung cancer; Serum cytokeratin 19 fragment; Carcinoembryonic antigen; Squamous cell carcinomaantigen; Human epididymis protein 4; Progastrin-releasing peptide; Pathological type; Differentially diagnostic value