胃泌素释放肽前体和神经元特异性烯醇化酶联合检测在小细胞肺癌诊断中的应用

Application of gastrin release peptide prosoma and nerve cell specificity enolase unite to detect minicell lung cancer diagnosis

目的:探讨血清胃泌素释放肽前体(ProGRP)和神经元特异性烯醇化酶(NSE)分别和联合检测在小细胞肺癌(SCLC)中的临床应用价值。方法:采用ELISA法检测44例SCLC,29例非小细胞肺癌(NSCLC),15例肺良性疾病,17例正常健康者血清ProGRP和NSE值。采用ROC曲线比较两者的诊断水平。结果:SCLC组血清ProGRP和NSE值显著高于其它对照组,广泛期(ED)NSE水平显著高于局限期(LD),LD期ProGRP的升高幅度大于NSE,二者均值分别是正常人均值的4.6倍和3.42倍。ProGRP和NSE诊断SCLC的敏感性分别为68.2%和59.1%,特异性为87.1%和79.0%。ED期NSE的敏感性(81.3%)显著高于LD期(46.4%)。血清ProGRP和NSE区分SCLC和NSCLC,LD和ED的ROC曲线下面积有显著性差异。化疗前NSE水平正常的SCLC患者化疗后完全缓解的占58.8%,而NSE升高的化疗患者完全缓解的占32.1%。在临床分期上,从数字来看,血清ProGRPⅢ、Ⅳ期水平高于Ⅰ、Ⅱ期,从统计学上得知,Ⅲ、Ⅳ期与Ⅰ、Ⅱ期血清ProGRP未见明显差别,而血清NSE无论在数字上和统计处理上Ⅲ、Ⅳ期明显高于Ⅰ、Ⅱ期水平。结论:ProGRP和NSE是有效的SCLC肿瘤标志物,ProGRP适用于SCLC的早期诊断,以及与NSCLC的鉴别诊断;NSE有助于SCLC的分期和评估化疗效果。将ProGRP和NSE联合检测,优势互补,在SCLC中有重要的临床应用价值。

Objective：To study the diagnostic value of serum level of pro-gastrin-releasing-peptide31-98 （ProGRP31-98） and neuron-specific enolase （NSE）,separately testing and combination testing for small-cell lung cancer （SCLC）. Methods：Serum level of ProGRP31-98 and NSE was measured by ELISA in 44 patients with SCLC, 29 patients with non-small-cell lung cancer（NSCLC）, 15 patients with benign lung disease and 17 normal subjects.Comparlng the diagnostic value of ProGRP31-98 and NSE receiving operating characteristic （ROC） curve. Result： Serum level of Pro-GRP31-98 ahd NSE was significantly increased in patients with SCLC than any other groups of patients. Serum level of NSE was higher in SCLC patients with extensive disease（ED） than in patients with limited diseases （LD）. Increasing of Pro-GRP31-98 in patients with LD was higher than that of NSE. The average of ProGRP31-98 and NSE was 4.6 times and 3.42 times higher than that of normal controls, respectively. Their sensitivity of diagnosis in SCLC was 68.2% and 59.1%, respectively. Their specificity was 87.1% and 79.0% separately. The sensitivity of NSE was higher in patients with ED than in patients with LD significantly. SCLC patients who gain effective chemotherapy and the disease was completely relieved were 58.8% of them prechemiotherapy .Their serum NSE levels were in the normal con- dition before chemotherapy. The completely relieved SCLC Patients with NSE level increasing was 32.1% of them before chemotherapy.It appears that there were an obvious superficial difference in serum Pro-GRP level between the patients in period Ⅲ,Ⅳand Ⅰ, Ⅱ ,but after taking statistics to the data, there were no substantial difference in fact, which tells us that there were some value for the early diagnosis of SCLC, However, for the NSE, both the data statistics disposal appears substantial differenceshetween the two groups of the patients. Conclusion：Pro- GRP31-98 and NSE were effective tumor marker of SCLC, ProGRP31-98 was fit for early diagnosis of SCLC and differential diagnosis of NSCLC. NSE was used for staging and evaluating chemotherapy effect of SCLC. Testing ProGRP31-98 and NSE had important clinical value.