非小细胞肺癌神经内分泌表达的检测及其临床意义

Detection of neuroendocrine differentiation in NSCLC and its clinical significance

目的 为研究非小细胞肺癌的神经内分泌分化状况及其对化疗疗效的影响。方法 应用Western印迹法和免疫组织化学方法分别检测了 42例非小细胞肺癌 (鳞癌 18例、腺癌 17例、大细胞癌 4例、肺泡细胞癌 3例 )组织中神经特异性烯醇化酶 (NSE)、嗜铬粒素A(CgA)和突触素 (SYN)的表达 ,并用电镜观察了上述病例的神经内分泌颗粒的超微结构。对 35位患者进行了化疗反应的观察。结果 (1)Western印迹法在非小细胞肺癌 (NSCLC)中检测NSE、CgA和SYN的阳性率分别为 6 6 7%、19 0 %和 33 3% ,均高于免疫组化的 45 2 %、9 5 %和 2 6 2 %。 (2 )Western印迹法和免疫组化的检测结果与肺癌的组织学类型和分化程度无明显关系。 (3)化疗有反应组的 3种标记物在免疫组化和Western印迹检测中阳性率均高于化疗无反应组 (P <0 0 5 )。结论 NSCLC中存在较高比例的神经内分泌分化 ,其中NSE阳性率最高 ,SYN次之 ,CgA的检出率则较低。Western印迹法和免疫组化对非小细胞肺癌中神经内分泌成分的诊断均有重要帮助 ,以Western印迹法更为敏感。神经内分泌分化可能是影响NSCLC对化疗反应的重要因素之一。

Objective To study differentiation of neuroendocrine (NE) in non small cell lung carcinoma (NSCLC) and its effect on the responsiveness to chemotherapy. Methods Neuron specific enolase (NSE), chromogranin A (CgA) and synaptophysin (SYN) were detected in 42 cases of NSCLC by using Western blot and immunohistochemistry Electron microscopy was also used to observe the ultrastructure of NE granule in above specimens.The relationship between the chemotherapeutic responsiveness and the differentiation of NE in carcinoma tissues was evaluated. Results (1) The positive rate of NE detected by Western blot is higher than that detected by immunohistochemistry and electron microscopy (2) There is no relationship between the expression of NE and the type of lung carcinoma as well as the differentiated degree of carcinoma (3) The positive rate of three markers detected by immunohistochemistry and Western blot methods in the group of responsive to chemotherapy is higher than that in non responsive group ( P <0 05). Conclusions There is a high rate of NE differentiation in NSCLC, of which NSE′s rate is highest, SYN takes second place, and CgA′s rate is lowest Immunohistochemistry and Western blot method are both very useful for the diagnosis of NE differentiation in NSCLC The sensitivity of Western blot is higher than immunohistochemistry The differentiation of NE may be one of the factors effected the chemotherapy in NSCLC