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目的：探讨血清肿瘤标志物癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19 片段（CYFRA21-1）联合经纤维支气管镜肺活检（TBLB）在周围型肺癌诊断鉴别中的应用价值。方法：选择2012 年9 月到2014年9 月在我院临床确诊的402 例周围型肺癌患者。检测所有患者的血清CEA、NSE 和CYFRA21-1 的浓度及分析TBLB 检测结果，分析不同病理类型和不同病灶直径大小时各项检测指标及联合检测的阳性检出率。结果：所有肺癌患者中，血清CEA、NSE、CYFRA21-1 和TBLB 的阳性检出率分别为51.74%，35.07%，41.79%和60.70%。四项指标联合检测的阳性检出率为89.05%，明显分别高于四项指标的阳性检出率（均P<0.05）。腺癌、鳞癌、小细胞肺癌及其他类型肺癌组四项联合检测的阳性检出率明显高于四项单独检测（均P<0.05）。病灶直径为<2 cm、2-6 cm 和>6 cm 时，四项联合检测的阳性检出率明显高于四项单独检测（均P<0.05）。结论：血清CEA、NSE、 CYFRA21-1 联合TBLB 检测周围型肺癌较单项检测，阳性检出率高，值得在临床上推广应用。

英文摘要:

Objective:To investigate the diagnostic value of serumCEA,NSE,CYFRA21-1 plus transbronchil lung biopsy(TBLB) detection in peripheral lung cancer.Methods:A total of 402 patients with peripheral lung cancer, who were treated in Tianjin No.254 Hospital from September 2012 to September 2014, were selected.Then the levels of serumCEA,NSE and CYFRA21-1 of all the patients were detected. The TBLB results and the positive rates of four separate detection and the combined detection in different types and lesion size of peripheral lung cancer were analyzed.Results:The positive rates of serum CEA, NSE, CYFRA21-1 and TBLB were 51.74%, 35.07%, 41.79%and 60.70%respectively, while the positive rate of combined detection was 89.05%, which was significantly higher than four separate detection (all P<0.05). The positive rates of combined detection in adenocarcinoma, squamous cell cancer, small cell lung cancer and other lung cancer groups were obviously higher than four separate detection (all P<0.05). The positive rates of combined detection in patients with <2 cm, 2-6 cm and>6 cm lesion diameter were obviously higher than four separate detection (all P<0.05).Conclusion:Serum CEA, NSE, CYFRA21-1 plus TBLB detection has higher positive rate in diagnosing patients with peripheral lung cancer compared with the four separate detection, which is worthy of clinical application and promotion.

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