【作者】 李黎； 张春玲； 于华； 王英年； 孙荣丽；

【机构】 青岛市中心医院青岛市结核肺病防治研究所；

【摘要】 目的:以细胞角质蛋白19片段(CYFRA211)、神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA) 为对照,研究肾上腺髓质素(adrenomedullin,AM)对肺癌诊断价值及与CYFRA211、NSE、CEA联合检测对肺癌与肺结核鉴别诊断意义,为肺癌与肺结核的诊治提供实验依据。方法:应用放射免疫法(RIA)分别检测肺癌、肺结核组病人、正常对照组外周血中AM、CYFRA211、NSE、CEA含量。结果:①肺癌组病人血浆中AM含量(98.46±29.28pg/ml)明显高于肺结核组(61.46±19.57pg/ml)及正常对照组(40.22±8.23 pg/ml),有极显著差别(P<0.01)。小细胞肺癌组病人AM含量较鳞癌、腺癌组病人AM含量低,有显著性差别(P<0.05)。鳞癌、腺癌组病人AM含量无明显差别(P>0.05)。随着肺癌病情的进展,从肺癌Ⅰ期至Ⅳ期AM逐渐升高,有显著性差异(P<0.05)。②AM、CYFRA211、NSE和CEA诊断肺癌的敏感性分别为65.1%、67.4%、46.5%和44.2%,特异性分别为91.2%、91.9%、95.3%和97.7%,准确性分别为84.5%、83.7%、79.1%和79.8%,AM诊断肺癌的敏感性、特异性、准确性与CYFRA2 11比较无显著性差别(P>0.05),AM诊断肺癌的敏感性、准确性较CEA高(P<0.05),③四项联合检测提高敏感性和准确性至90.7% 和92.2%,明显优于单项检测(P<0.05)。结论:①AM、CYFPRA211、NSE、CEA的检测可作为肺癌与肺结核鉴别诊断的实验室指标。②AM与CYFRA211、NSE、CEA的联合检测可进一步提高诊断敏感性和准确性,对提高肺癌鉴别诊断有较大的意义。⑥AM与CYFRA211、NSE、CEA的测定有助于判断肺癌病人的病情和预后。④研究提示AM参与肺癌的发生发展,推测干扰AM与其特异性受体的结合及信号转导途径可为肺癌的治疗开辟新的研究思路。更多还原

【Abstract】 Objective: To study the diagnostic value of detection of AM and combined detection of AMXYFRA211, NSE and CEA in differentiating lung cancer from pulmonary tuberculosis, comparing with CYFRA211 ,NSE and CEA, to prove the experimental basis of diagnosis and treatment of lung cancer. Method: The levels of AM, CYFRA211, NSE and CEA in pulmonary tumor, pulmonary tuberculosis and normal control group were determined by radioimmunoassay(RIA) Results: ① The level of AM (98.46 ± 29.28ng/ml) in the plasma of patients afflicted with lung cancer was higher than that in patients with pulmonary tuberculosis (61.46 ± 19.57 ng/ml) and normal controls (40.22 ± 8.23ng/ml), there was markedly statistical significance among them( P<0.01).The level of AM in the plasma of patients afflicted with small cell carcinoma was lower than that in the plasma of patients with lung adenocarcinoma and squamous cell carcinoma (P<0.05).There was no difference in patients with lung adenocarcinoma and squamous cell carcinoma (P>0.05 ).A positive correlation existed between the level of AM in the plasma of patients afflicted with lung cancer and the stage of this disease (P<0.05). ② The sensitivity of AM, CYFRA211, NSE and CEA for making diagnosis of lung cancer were 65.1%, 67.4%, 46.5% and 44.2%, the specificity were 91.2%, 91.9%, 95.3% and 97.7%, the accuracy were 84. 5%, 83.7%, 79.1% and 79.8%. There was no difference between AM and CYFRA211 in the sensitivity, specificity and accuracy for making diagnosis of lung cancer (P>0.05). The sensitivity and accuracy of AM were higher than those of CEA (P<0.05). ③ The sensitivity and accuracy of the combined determination containing four tumor markers were 90. 7%and 92.2%,being higher than others in diagnosis of lung cancer (P<0.05). Conclusion: ① AM, CYFRA211, NSE, CEA can be regarded as laboratory marks of differentiating lung cancer from pulmonary tuberculosis.②Combined detection of AM, CYFRA211, NSE and CEA can significantly improve the sensitivity and the accuracy in diagnosis of lung cancer .③ The levels of AM, CYFRA211, NSE, CEA can reflect the condition and the prognosis of the patient with lung cancer. ④This research shows that AM is closely correlated with lung cancer.disrupting the binding of AM its receptor or signal transduction pathways could be a new way to cure lung cancer更多还原