神经元特异性烯醇化酶在非霍奇金淋巴瘤中的临床应用价值

Clinical Value of Neuron-Specific Enolase in Patients with Non-Hodgkin's Lymphoma

【目的】探讨神经元特异性烯醇化酶(NSE)在非霍奇金淋巴瘤(NHL)中的表达及其与近期疗效和预后的关系。【方法】采用电化学发光法检测216例初诊NHL患者治疗前后的血清NSE水平,分析NSE的表达与近期疗效和预后的关系,免疫组化方法检测可获取的95例病理组织中NSE的表达,分析血清NSE的表达同肿瘤组织中NSE表达的相关性。并测定50例对照组患者的血清NSE水平,有发热、淋巴结肿大,最后排除为恶性疾病者为对照组。【结果】216例NHL患者初诊时血清NSE平均水平为(24.89±1.769)ng/mL,明显高于对照组(8.21±3.143)ng/mL水平,差异有统计学意义(P<0.001);其中136例NHL的NSE水平高于正常参考值上限(15.20ng/mL),阳性表达率为62.96%,且NSE非特异性表达于NHL各病理亚型中;4个疗程治疗后全组患者均可评价疗效,总有效率为69.9%(161/216),完全缓解率为50.9%(110/216),初诊NSE水平正常组近期有效率明显高于升高组,差异有统计学意义(P<0.050);血清NSE水平升高组和正常组5年生存率分别为35%及72%(P<0.001);血清NSE水平在年龄大于60岁、血清LDH升高、有B症状、IPI2-5分、AnnArbor分期Ⅲ-IV期的患者明显高于对照组患者,差异有统计学意义(P<0.05),Cox模型多因素分析显示治疗前血清NSE水平是216例NHL患者独立的预后影响因素(P<0.001),95例病理标本免疫组化胞浆NSE的阳性检出率为49.47%(47/95),且血清NSE的阳性表达同病理免疫组化测得的NSE的阳性表达呈正相关,(r=0.773,P<0.050)。【结论】血清NSE可能由NHL细胞产生,对NHL近期疗效及预后有重要临床参考价值。

[objective] The present study was to examine the expression of neuron-specific enolase（NSE） in patients with non-Hodgkin＇s lymphoma（NHL） and determine its clinical and prognostic value.[Methods] Serum NSE values were measured using an electrochemiluminescence immunoassay in 216 patients with NHL when initial diagnosis and after 4 cycles of chemotherapy.Serum NSE expression and its clinical and prognostic significance were examined.Also,immunohistochemical expression of NSE in 95 NHL patients tissue were evaluated and its correlation with serum NSE expression was analyzed.In addition,serum NSE value was measured for 50 patients with fever or swollen lymph nodes et al.but finally ruled out a malignat disease served as a control group.[Results] The mean value of serum NSE for 216 NHL was（24.89 ± 1.77）ng/mL,significantly higher than that of control group（8.21 ± 3.143）ng/mL.Serum NSE values 15.20 ng/mL were detected in 136 of 216 patients with NHL（62.96%）.After 4 cycles of chemotherapy,all patirents were eligible for response evaluation.The response rate（RR） for the whole group was 69.9%（161/216） with complete response（CR） rate of 50.9%（110/216）.The response rate was much higher in NSE negative（NSE 15.20 ng/mL） than NSE positive（NSE 15.20 ng/mL）.The 5-year overall survival（OS） rates in NSE positive and negative were separately 35% and 72%（P 0.001）.Serum NSE value in patients with age 60 years,elevated serum LDH,presence of B symptoms,IPI score 2-5,Ann Arbor stage Ⅲ-IV was significantly higher than the control group（P 0.05）.Multivariate analysis in Cox model showed that serum NSE value before treatment was an independent significant prognositic factor for 216 NHL patients（P 0.001）;the positive expression of NSE in 95 patients tissue was 49.47%（47/95）,and there was a positive correlation between the serum and tissue NSE expression.（r = 0.773,P 0.050）.[Conclusion] Serum NSE may be produced by NHL tumor cells and as well as an independent prognostic factor of NHL and be of significant clinical value.