血清嗜铬素A在胃肠胰神经内分泌肿瘤临床诊断和疗效评价中的应用

Application of serum chromogranin A in clinical diagnosis and efficacy evaluation of gastroenteropancreatic neuroendocrine neoplasm

目的探讨血清嗜铬素A对胃肠胰神经内分泌肿瘤（GEP—NEN）诊断和疗效评价的价值。方法纳入2011年1月至2012年12月确诊为GEP—NEN的87例患者，包括50例有病灶者和37例术后无病灶者，同时将84名健康体检者作为健康对照组，采用ELISA法测定所有受试者的血清嗜铬素A水平。统计学方法采用非参数检验、ROC曲线和单因素Cox回归分析。结果有病灶组患者血清嗜铬素A水平中位数为97μg／L，高于术后无病灶组的42／μg／L（Z=3．451，P=0．001）和健康对照组的47μg／L（z=3．149，P=0．002）。以95／μg／L作为健康者或无病灶患者与有病灶患者的诊断临界点，其检测敏感度为54．0％，特异度为90．1％。有远处转移患者血清嗜铬素A水平中位数为231μg／L，高于无远处转移患者的46μg／L（Z=3．340，P=0．001）。治疗后血清嗜铬素A较基线水平下降≥20％的12例患者，其肿瘤完全缓解、部分缓解或稳定；血清嗜铬素A较基线水平升高≥20％的5例患者，其肿瘤出现进展。单因素Cox回归分析显示，GEP—NEN患者血清嗜铬素A水平与预后无关（r=1．000，P=0．252）。结论神经内分泌肿瘤标志物嗜铬素A对于GEP-NEN有较高的诊断价值，可作为临床诊断GEP—NEN和疗效评价的重要标志物。

Objective To explore the value of serum chromogranin A （CgA） in clinical diagnosis and efficacy evaluation of gastroenteropancreatic neuroendocrine neoplasm （GEP-NEN）. Methods From January 2011 to December 2012, 87 GEP-NEN patients were enrolled, which included 50 patients with lesions and 37 patients without lesions after surgery. Eighty-four healthy subjects were taken as control group. The serum CgA levels of all subjects were measured with enzyme linked immunosorbent assay. Nonparametric test, receiver operating characteristic curve and Cox regression univariate analysis were performed for analysis. Results The median of serum CgA level of GEP-NEN patients with lesions was 97 μg/L, which was significantly higher than that of patients without lesions after surgery （42 μg/L, Z=3. 451, P=0. 001） and healthy control （47 μg/L, Z=3. 149, P= 0. 002）. The value of 95 μg/L was taken as diagnostic cut-off value for healthy controls, patients without lesions and patients with lesions, the sensitivity and specificity were 54. 0% and 90. 1%, respectively. The median of serum CgA level of the patients with distant metastasis was 231 μg/L, which was higher than that of patients without distant metastasis （46 μg/L, Z= 3. 340, P= 0. 001）. After treatment, the serum CgA levels of 12 patients with complete remission, partial remission orstable tumor decreased more than 20% of baseline values. The serum CgA levels of five patients increased more than 20%of baseline values and the tumors of them showed progress. Cox regression analysis showed that there was no correlation between CgA levels of patients with lesions and prognosis （r=l. 000, P=0. 252）. Conclusion Neuroendocrine marker CgA has high diagnostic value in GEP-NEN, and can be used as an important biomarker in clinical diagnosis and efficacy evaluation of GEP-NEN.