胃泌素释放肽前体和神经元特异性烯醇化酶对小细胞肺癌诊断的差异及联合检测

Value of pro-GRP and NSE in the diagnosis of small-cell lung cancer difference and combination detection

目的 探讨pro-GRP与NSE水平对SCLC临床诊断、疗效监测的意义及治疗后标志物水平与生存期的关系.方法 回顾性研究.收集2008年5月1日至2011年4月30日由郑州人民医院确诊的41例SCLC（男30例,女11例,年龄46 ～ 78岁）、95例NSCLC（男55例,女40例,年龄42～88岁）和127名健康人（男80名,女47名,年龄35～ 78岁）样本,检测pro-GRP和NSE的血清学水平,分析评价2项指标在SCLC患者治疗前后的水平变化.采用SPSS 16.0单因素方差分析、随机区组设计的方差分析和log-rank test进行统计分析.结果 SCLC患者治疗前血清pro-GRP中位数水平为357.8 ng/L,NSE治疗前中位数水平为89.5 μg/L,两者均显著高于NSCLC组指标的中位数水平（pro-GRP：39.9 ng/L; NSE：11.43 μg/L）和健康人组指标的中位数水平（pro-GRP：12.7 ng/L; NSE：10.03 μg/L）（F值分别为41.05、100.42,P均＜0.001）.pro-GRP和NSE诊断SCLC的敏感度分别为80.4％和78.0％,特异度分别为92％和87％;两指标血清水平上相关性较低（r=0.2750）,联合检测SCLC敏感度可达95％,特异度可达85％;SCLC-LD患者治疗前、后pro-GRP水平的差异有统计学意义（F=3.53,P=0.038）,NSE的水平在SCLC-ED患者治疗前、后的差异有统计学意义（F=16.049,P =0.000）.部分缓解的SCLC患者治疗后NSE水平低于界值的患者生存期长于高于界值的患者（P =0.001）.结论 pro-GRP和NSE联合检测诊断SCLC的灵敏度优于单指标;pro-GRP水平更能反映SCLC-LD患者的治疗效果,NSE水平则更能反映SCLC-ED患者的治疗效果.治疗后NSE水平对评估部分缓解患者的生存期有一定价值.

Objective To study the serum levels of progastrin-releasing peptide （pro-GRP） and neuron-specific enolase （NSE） for the clinical diagnosis,therapy monitoring and survival time analysis of small cell lung cancer （SCLC）.Methods All 41 SCLC samples （30 males,11 females,age range from 46 to 78 years）,95 NSCLC samples （55 males,40 females,age range from 42 to 88 years）,and 127 normal individuals samples （80 males,47 females,age range from 35 to 78 years） which were diagnosed by People＇s Hospital of Zhengzhou from May 1,2008 to April 30,2011 were collected.Serum levels of pro-GRP,NSE and their changes in SCLC patients before and after therapy were evaluated.ANOVA analysis,randomized block design analysis of variance and the log-rank test were collected SPSS 16.0 to evaluate the survival time.Results The serum levels of pro-GRP （median 357.8 ng/L） and NSE （median 89.5 μg/L） in SCLC group were significantly higher than those in the NSCLC group （pro-GRP：39.9 ng/L;NSE：11.43 μg/L） and normal individuals group （pro-GRP：12.7 ng/L;NSE：10.03 μg/L） （P=0.000）.The sensitivity of pro-GRP and NSE for the diagnosis of SCLC were 80.4％ and 78.0％,while the specificity were 92％ and 87％,respectively.There is a poor correlation between pro-GRP and NSE serum levels,but when combined the sensitivity can be 95％ and specificity can be 85％.Significantly statistical difference of pro-GRP levels was observed in the different stages of treatment （before and after therapy） in SCLC-LD patients （F =3.53,P =0.038）,and significant statistical difference of NSE levels was also observed in SCLC-ED patients in different stages （F =16.049,P =0.000）.In partied response SCLC patients,the group with NSE level lower than cut-off value had longer survival time than the other group with NSE level higher than cut-off value （P =0.001）.Conclusions The sensitivity of the combined analysis of pro-GRP and NSE is better than single marker for the diagnosis of SCLC.The serum level of pro-GRP has better correlation with therapeutic effect of SCLC-LD patient than NSE.The serum level of NSE are well correlated with therapeutic effect in SCLC-ED patients.There are some certain value of NSE level for evaluation the survival time of SCLC patients who were in partial response.